TUR Syndrome

Intravascular absorption of a large volume of irrigating fluid without electrolytes during transurethral resection of the prostate can cause a so-called TUR syndrome.

™ Pathophysiology: hypo-osmolar, electrolyte-free, hypotonic hyperhydration (hypervolemic, hypo-osmolar, hyponatraemia, acidosis). First of all, nonspecific clinical symptoms (frequent yawning, agitation, feeling cold, periphery cyanosis), sudden development of hyper- or hypotension with bradycardia, then quick development of circulatory disturbance, hyponatriaemic shock with kidney failure, brain and lung oedema possible.

™ Treatment: patient should be managed in the intensive care unit, given 100% oxygen, replace sodium only if serum sodium is below 120 mmol/l and at a rate of not more than 10 mmol/h (very slow infusion with 200 ml hypertonic 3% normal saline). Give Lasix in every case and in certain cases also give mannitol. To improve left ventricular function, give nitrate and dobutamine.

™ Prophylactic measures: limit the hydrostatic pressure of the irrigating fluid to 50-60 cm water, limit the operating time of resection (60 min of resection time) and close patient monitoring, optimized by regional anaesthesia.

™ 2% volume ethanol can be added to the irrigation fluid routinely. With the concurrent measurement of expiratory alcohol concentration with an alcometer, real-time monitoring of the absorption of irrigation fluid (Widmark-formula) can be measured and then TUR syndrome can be avoided [1, 2].

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