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TURP Syndrome

Dra. Nancy Foster Arzamendi

Bibliografía:

Definición

Es una complicación que puede ocurrir durante una resección transureteral de próstata caracterizada por síntomas relacionados a inyección de fluido con hiponartremia con un cuadro clínico variable.

The overall mortality is 0.2–0.8%

Resección transureteral de próstata

Procedimiento más común en adultos mayores de 60 años. La irrigación de los plexos venosos de la próstata de más de 2 litros de solución puede condicionar este síndrome.

Soluciones de irrigación

Técnica anestésica

Factores de riesgo

  • size of the opened venous sinuses
  • the amount of the irrigation fluid used
  • using excess amounts of hypotonic intravenous fluids
  • the duration of the resection

The risk is increased if the duration of the resection is longer than 60 min. Approximately 10–30 ml of fluid is absorbed during resection. Thus, 1800 ml of fluid can be absorbed if the resection lasts for 1 h.

Cuadro clínico

Variable.

It may present as early as 15 min after resection starts or as late as 24 h after operation.

Acute neurological symptoms (such as confusion and coma) must be treated rapidly, especially if the patient has central pontine myelinolysis which is associated with depressed awareness, difficulty speaking and swallowing, impaired thinking, weakness or paralysis in the arms and legs, stiffness, impaired sensation and difficulty with coordination.

Since our patient was under general anaesthesia, he only displayed bradycardia and hypotension

Cuadro clínico

In patients under spinal anaesthesia, neurological symptoms including vomiting, confusion and irritability can easily be noticed. Early changes under general anaesthesia are related to the cardiorespiratory system and include decreased oxygen saturation and ECG changes.9 ST segment changes in the ECG support the diagnosis. The peripheral oxygen saturation of all patients must be monitored. Our patient was under general anaesthesia, therefore it was not noticed, impaired consciousness and the impairment of haemodynamic parameters led us to the diagnosis of TURP syndrome.

Hiponartremia

Hyponatremia symptoms do not generally manifest until serum sodium concentrations are below 120 mmol/l. If the plasma is severely hypotonic (Na+ <100 mmol/l), acute intravascular haemolysis may occur.

Hiponartremia

Tratamiento

Primero se debe suspender el procedimiento quirúrgico de inmediato. Se suspende administración de soluciones IV, se administran diuréticos como furosemide.

En casos donde hay alteraciones neurológicas, se inician soluciones hipertrónicas de 3 a 5%.

No dar más de 100 mmol/hr en caso de Na mayor de 120 mmol/l.

Tratamiento

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