The transurethral resection of the Prostate (TURP) syndrome and acute dilutional hyponatraemia (HN): A comprehensive literature review from first incidence in 1947 to disappearance in 2018

Abstract

Introduction and objective: To report on the literature review on the TURP syndrome from its first report in 1947 to disappearance from urology in 2018 Material and methods: The literature on the TURP syndrome from 1947 to 2018 was reviewed. We summarise the evidence on its incidence, prevalence, patho-aetiology, clinical picture and management. With the introduction of normal saline as irrigating fluid for the TURP procedure, the TURP syndrome as characterised with hyponatraemia (HN) has been eradicated. We introduce the concept of volumetric overload shocks (VOS) to be prepared when another syndrome induced by saline overload strikes. Results: The TURP syndrome is induced by massive absorption of the sodium-free irrigating fluid and is characterized with acute dilutional HN- hence it is eradicated with use of saline as irrigant. It presents with shock and multiple vital organ dysfunction and was easily mistaken for one of the recognised shocks calling for further volume expansion with isotonic solutions with disastrous consequences. Identifying the concept of VOS does not only help in the management of the TURP syndrome but also with recognizing the syndrome induced by saline overload. Hypertonic sodium therapy has proved effective in treatment. Conclusion: The review demonstrates that VOS in clinical practice is of two types; Type 1 (VOS1) induced by sodium-free fluid and type 2 (VOS2) induced by sodium-based fluids- the later has no serum marker of HN. Both conditions present with multi-system organ dysfunction but one system may predominate. VOS2 presents as the adult respiratory distress syndrome.