Transurethral Resection Of Prostate Syndrome Research Articles

Spinal Anestesi Pada Tindakan Transuretral Resection Of Prostat (TURP)

Spinal anesthesia is the choice for Transurethral Resection of Prostate (TURP) procedures. TURP is a surgical procedure performed for patients with prostatic hyperplasia. When a TURP procedure is performed, excessive fluid absorption will occur because during the procedure the injured area causes the vein to open and irrigation fluid will be absorbed. The position of the surgical procedure in the lithotomy position makes the situation worse. Spinal anesthesia helps peripheral blood collection and reduces circulatory overload, early detection of TURP syndrome and bladder perforation. In this case, the procedure was carried out on a 67 year old man with a diagnosis of benign prostate hyperplasia (BPH) with a TURP surgical procedure. The patient was composmentis, ASA III. The patient underwent spinal anesthesia with a sub arachnoid block using Bupivacaine. During TURP procedures, TURP syndrome can occur which is influenced by the use of fluid as irrigation to widen the operator's field of view. Saline fluid should be used, but because it is expensive, H2O is often used as irrigation fluid. A complication of the TURP procedure is TURP syndrome

Incidence and outcome of transurethral resection of prostate syndrome at a tertiary care hospital

Introduction: Monopolar transurethral resection of prostate (M-TURP) is rarely complicated with the dreaded syndrome the TURP syndrome due to absorption of larger amount of non-electrolyte hypo-osmolar irrigation fluid (1.5% glycine), longer duration of surgery and larger amount of tissue resection. This study aims to find out the incidence and perioperative outcome of TURP syndrome after monopolar TURP. Method: This was a cross sectional study of retrospectively collected data during the period of 4 years from June 1st 2018 to 30th May 2022, in Department of Urology of Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of the incidence of TURP syndrome, its relation with amount of resected tissue, duration of resection time, and the outcome (need of blood transfusion, length of hospital stay, mortality). Result: Out of 208 cases of monopolar TURP, 8/208(3.8%) had TURP syndrome. Patients with TURP syndrome were age group 70-85 y. Duration of surgery was >60 min was in 5/8(62.5%), resection weight >20 gm 6/8(75%), blood transfusion 1/8(12.5%), and hospital stay >3 days in all 8/8(100%) cases. Mortality was nil in patients with TURP syndrome. Conclusion: The TURP syndrome was observed in 8/208(3.8%) and it was more common in older (>60y) with longer duration (>60 min) of surgery, and larger amount of prostatic tissue (>20gm) resection.

Serial perioperative optic nerve sheath measurements for early diagnosis of the transurethral resection of prostate syndrome: an open label pilot study

BackgroundUltrasound imaging of optic sheath nerve diameter [ONSD] is reported to reflect changes consistent with intracranial pressure changes seen in traumatic brain injury and also in documented serum hyponatremia. We hypothesized that hyponatremia and hypervolemia seen during trans urethral resection of prostate [TURP] surgery may also have some association with different ONSD readings from the baseline perioperatively, resulting in early detection of TURP syndrome. In this prospective observational study, 50 adult male patients scheduled for TURP surgery meeting inclusion criteria were included and the ONSD measurements were serially recorded perioperatively. Patients with measurements ≥ 5.2 mm with either clinical symptoms or electrolyte changes suggested TURP syndrome were taken as true positive.ResultsThe sensitivity, specificity, area under the curve, positive predictive, and negative predictive value at 95%CI of ONSD for early detection of TURP syndrome was {100% [15.81 to 100.00%], 91.67% [80.02 to 97.68%], 0.96 [0.86 to 0.99%], 33.33% [4.33 to 77.72%], 100% [91.96 to 100.00%]} with a diagnostic accuracy of 95.83%. In univariate logistic regressions, the duration of surgery had a positive association with TURP syndrome [odd ratio 1.066, β coefficient 0.064, p = 0.015]. In multivariate logistic regression, we could not validate the association between these factors and TURP syndrome [p > 0.050].ConclusionsThe ONSD measurements have good diagnostic accuracy for detecting TURP syndrome, but we advocate more multi-centric studies with large sample sizes to validate this association in the multivariate regression model.

Initiating Continuous Renal Replacement Therapy in Patients With Transurethral Resection of Prostate Syndrome: A Case Report

With advances and developments in hysteroscopy, cystoscopy, transurethral resection of bladder tumor, and arthroscopy, transurethral resection of prostate (TURP) syndrome has been increasingly reported. TURP syndrome is often accompanied by severe hyponatremia, fluid overload, and a plasma hypotonic state, resulting in heart failure and pulmonary and cerebral edema. Conventional treatment methods, such as intravenous infusion of hyperosmotic saline, can rapidly reverse the downward trend of serum sodium levels in efforts to prevent and treat cerebral edema. However, this may not be suitable for patients with cardiac and renal insufficiency and may induce central pontine myelinolysis due to the possibility of worsening volume load and difficulty in controlling the correction rate of serum sodium. The patient described in this report presented with severe hyponatremia (sodium<100 mmol/L) combined with intraoperative pulmonary edema; his cardiac function and oxygenation status deteriorated after an intravenous infusion of 3% hypertonic saline. He underwent continuous renal replacement therapy (CRRT) to prevent the progression of multiple–organ edema and cardiac insufficiency. CRRT has demonstrated efficacy in the treatment of chronic hyponatremia in patients with renal failure, and can slowly and continuously correct water-electrolyte imbalance, acid-base imbalance, and volume overload. TURP syndrome with severe hyponatremia and pulmonary edema was diagnosed; accordingly, the patient was treated with 3% hypertonic saline, furosemide, and CRRT, without the development of overt neurological sequelae.

Descriptive study of post-operative complications of transurethral resection of prostate

Introduction: Because of the introduction of improved technology like diathermy and visual scopes, Transurethral resection of prostate (TURP) has become a comparatively safer treatment in recent years. However, there is a danger of developing TURP syndrome and electrolyte imbalance, particularly in individuals with high-risk cardiac disease. Aim: This study was performed for the identification of course, duration, and occurrence of complications in post-operative patients with TURP. Materials and Methods: A descriptive study comprising 52 patients was conducted at C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India from 8th February 2019 to 1st November 2020, covering 20 months. Results: The study focused on the distribution of patients as per age and post-op complications, co-morbid conditions, DRE grading, etc. Also, the study correlates the volume of the prostate with post-operative complications, prostate volume with S-PSA, etc. Furthermore, the study focused on early complications after TURP as well as late post-operative complications after TURP. Conclusion: This descriptive observational study highlighted several postoperative complications after TURP. It was observed that the incidence of complication rate is increasing with an increasing volume of the prostate.

Descriptive study of post-operative complications of transurethral resection of prostate

Introduction: Because of the introduction of improved technology like diathermy and visual scopes, Transurethral resection of prostate (TURP) has become a comparatively safer treatment in recent years. However, there is a danger of developing TURP syndrome and electrolyte imbalance, particularly in individuals with high-risk cardiac disease. Aim: This study was performed for the identification of course, duration, and occurrence of complications in post-operative patients with TURP. Materials and Methods: A descriptive study comprising 52 patients was conducted at C.U. Shah Medical College and Hospital, Surendranagar, Gujarat, India from 8th February 2019 to 1st November 2020, covering 20 months. Results: The study focused on the distribution of patients as per age and post-op complications, co-morbid conditions, DRE grading, etc. Also, the study correlates the volume of the prostate with post-operative complications, prostate volume with S-PSA, etc. Furthermore, the study focused on early complications after TURP as well as late post-operative complications after TURP. Conclusion: This descriptive observational study highlighted several postoperative complications after TURP. It was observed that the incidence of complication rate is increasing with an increasing volume of the prostate.

Diathermy smoke induced asthmatic attack during transurethral resection of prostate

The use of diathermy and other electrosurgical devices have become an indispensible and integral part of modern surgical practice. This revolutionary benefit to surgery have been associated with the release of toxic agents that represents a potential health risk. A 79 year old who had an asthmatic attack during transurethral resection of prostate (TURP) on account of benign prostate enlargement. He was a known asthmatic, incidence of attacks had become infrequent over the years, and the last asthmatic attack was over 10 years ago. Triggers for attacks were strong smell, smoke and dusty environment. He had no other systemic disease of note. The procedure was done under subarachnoid block. Thirty minutes into the procedure, he was noticed to have difficulty in breathing and coughing, there was tachycardia and elevated blood pressure. The patient oxygen saturation was between 88-92% on room air, chest auscultation revealed a wide spread rhonchi. Oxygen via a non-rebreather face mask with reservoir bag at 10L/min was commenced and intravenous hydrocortisone 200mg was given. Forty minutes into the procedure, patient’s condition did not improve. Procedure was discontinued and patient moved to the ward, patient was nebulized, intravenous aminophylline 250 mg given slowly, with repeated nebulization and continued oxygenation, patient condition improved. An immediate postoperative serum electrolyte, urea and creatinine done showed normal values to rule out TURP syndrome.

MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY

You have accessJournal of UrologyCME1 May 2022MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY Kirby R. Qin, William Wang, Damien Bolton, and Gregory Jack Kirby R. QinKirby R. Qin More articles by this author , William WangWilliam Wang More articles by this author , Damien BoltonDamien Bolton More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery. METHODS: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean±SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression. RESULTS: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1±8.9 vs 71.2±8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3±35.0 cc vs 67.7±38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5±11.7 vs 26.6±25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7±26.6 vs 75.7±29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8±57.2 vs 74.7±42.7 minutes, p=0.07) and length-of-stay (2.5±2.0 vs 2.3±3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p<0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37). CONCLUSIONS: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e476 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirby R. Qin More articles by this author William Wang More articles by this author Damien Bolton More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

TURP syndrome: A rare case report from Syria

Introduction an importanceTransurethral resection of prostate (TURP) is a rare but extremely dangerous condition. Although this complication is well described previously, we still see it those days.Case presentationWe report a case of 66-year-old male patient presented with symptoms of enlarged prostate. Ultrasound showed the prostate weight was 90 g. He was scheduled for transurethral resection of prostate. The procedure took 65 min with the use of monopolar device. One hour after operation, he had confusion, bradycardia, and elevated blood pressure. Laboratories showed hyponatremia and hyperkalemia. We infused the patient with saline 3% solution after the diagnosis of TURP syndrome. On next day, he gained his full recovery and we discharged him.Clinical discussionOur patient suffered from TURP syndrome. Laboratory evaluation of blood electrolytes led to confirm the diagnosis. We immediately infused hypertonic saline intravenously. We monitored the patient clinically and with serial assessments of blood electrolytes.ConclusionTURP syndrome is considered a serious complication in urology surgery. Urologists should suspect this complication in prolonged TURP surgery. Early diagnosis is crucial to save patient's life.

A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS CORRELATION OF CAVAL AORTA INDEX WITH CENTRAL VENOUS PRESSURE FOR INTRAVASCULAR VOLUME ASSESSMENT IN PATIENTS UNDERGOING ENDOSCOPIC TRANSURETHERAL RESECTION OF PROSTATE (TURP)

INTRODUCTION: There are various techniques for assessing the uid status such as clinical examination, central venous pressure (CVP) measurement, biochemical markers, bio impedance, continuous blood volume measurement, or sonographic inferior vena cava (IVC) diameter assessment. Sonographic evaluation of the IVC and Aorta diameter and its usefulness in evaluating the volume status are studied and documented. The sonographic evaluation of the IVC &amp; Aorta can predict the volume status, this tool can assist anesthetist in rapid diagnosis and prompt resuscitation of patients developing TURP syndrome AIM OF THE STUDY: The aim &amp; objective of this study is to assess the correlation of Caval Aorta index with CVP in intravascular volume assessment in patients undergoing endoscopic Trans Urethral Resection of Prostate (TURP) MATERIALS AND METHODS: The study is carried out in the Department of Anaesthesiology involving Department of Urology in Kanyakumari Government Medical College from January 2018 to June 2019. It is a Prospective observational study. To measure the IVC diameter USG machine probe is placed in the sub-xiphoid region to visualize the conuence of the hepatic veins draining the IVC. The maximum internal AP diameter of the Aorta(Ao) and maximum internal anterior-posterior (AP) diameter of the IVC is measured in the longitudinal plane. Fluid status will be measured by CVP and IVC/Ao index recorded before neuraxial block, after preload, at 5 min after intrathecal block, resection time at 0 min, every 15 min during the rst 30 min, then every 30 min, until the end of surgery. Outcome: Incidence of hypotension after spinal anesthesia in a cesarean section RESULTS: The mean IVC diameter at pre-operative is 15.20±1.42, and at 60 min, 75 min were 19.39±1.92, 20.03±1.76 which suggests that the size and shape of the inferior vena cava (IVC) is correlated to the CVP and circulating blood volume. In my study the mean Aortic diameter at 60 min, 75 min were 20.30±1.01 and 19.81±1.06 which is same as the preoperative level (19.72±1.18) and diameter. The mean CVP at pre-operative is 4.57±0.73, mean CVP at 60 min, 75 min were 7.57±0.82, 8.11±0.78 which denotes that CVP increases as the intravascular volume status increases. In our study mean IVC/Aortic index at pre-operative is 0.77±0.05 and the mean IVC/Aortic index at 15min, 30 min, 60 min, 75 min were 0.87±0.03, 0.90±0.04, 0.95±0.06, 1.01±0.05 which increases signicantly in increasing intravascular volume. The strong correlation between these two variable with Pearson formula ranging from 0.450-0.900. CONCLUSION: As Sonographic caval Ao index is very well correlated with CVP , IVC/Ao index is useful for the evaluation of preoperative and intraoperative volume status, especially in major surgeries with marked uid shift or blood loss and had the advantage of being noninvasive, safe, quick, and easy technique with no complications.

Role of preoperative assessment of serum sodium in transurethral resection of prostate to avoid transurethral resection of prostate syndrome: a comparative study

Background: Transurethral resection of prostate syndrome (TURP) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery.Methods: A total of 100 patients with benign prostatic hyperplasia (BPH) were taken for study. Study was done in tertiary care centre in Gujarat from January 2016 to December 2017. They were evaluated pre-operative and post-operative for sodium concentration.Results: In this study most of the patients i.e. 32 were seen in age group 61- 65 years.31% cases have developed hyponatremia out of 6% were having serum sodium level &lt;125 mEq/l. 56% of cases were having prostate gland &lt;40 cc. In 70% cases, TURP was completed within 60 minutes, while 30% cases required more than 60 minutes time. 13 were seen in age group 51 to 60 years, means 40.62% patients of this age group (13/32) and 12 patients were seen in age group 71-80 years, means 52.17% patients of this age group (12/23) were having post-operative hyponatremia. Out of 31 patients, 20 patients (64.52%) were having prostate size more than 60 cc and 11 patients (35.48%) were having prostate size between 46 to 60 cc.Conclusions: From present study, it is concluded that electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigation fluid. It was also noticed that chances of electrolyte derangement are higher in patients with co-morbid conditions.

Prophylaxis versus Treatment against Transurethral Resection of Prostate Syndrome: The Role of Hypertonic Saline.

Background:This study aimed at investigating the usage and effects of prophylactic hypertonic saline (HS) to prevent the occurrence of transurethral resection of the prostate (TURP) syndrome.Materials and Methods:Sixty American Society of Anesthesiologists physical status classes I–III candidates for TURP using the monopolar resectoscope were randomized into three groups 20 patients each. Group A received 4 mL.kg-1.h-1 HS 3%; Group B received 2 mL.kg-1.h-1 HS 3%; and Group C received 6 mL.kg-1.h-1 normal saline. Hemodynamics, vasopressors need, electrolytes (sodium, potassium, and chloride), osmolality, and arterial-blood gas (ABG) were recorded. The incidence of transurethral resection syndrome, intensive care unit (ICU) admission, postoperative ventilation, hospital stay as well as any adverse events were noted.Results:Hypernatremia was detected in six patients (P = 0.002) of Group A only, while hyponatremia occurred in five patients (P = 0.009) of Group C alone. Serum sodium in Group C showed a significant decrease starting from T2 (1 h postresection) till Tp3 (48 h postoperative). In Group C, five patients experienced hypotension and bradycardia; hypertensive episodes also occurred in five patients and a hypervolemic state was noted in seven patients. TURP syndrome was confirmed in only five patients, all in Group C (P = 0.009). Postoperative ICU admission was needed for seven patients of C Group, five of which required assisted ventilation. The overall hospital stay was longer for Group C patients.Conclusion:Prophylactic administration of HS during TURP is superior to conventional treatment of an occurred TURP syndrome. Low dose (2 mL.kg-1.h-1 HS 3%) is effective without adverse effects or risk of contrary hypernatremia.

Biochemical Changes Using Sterile Water and 1.5% Glycine in TURP: A Randomized Study

Introduction: Endoscopic procedures in urology require irrigating fluid to provide a clear field of vision and to wash away debris. Glycine (1.5%) has been widely used, however sterile water is easily available and inexpensive. Excessive absorption of irrigation fluid can lead to dyselectrolytemia, hemolysis and systemic complications. In this study we compare 1.5% glycine with sterile water as irrigation fluid for Trans Urethral Resection Of Prostate (TURP). Materials and Method: In this prospective randomized study, we analysed 60 patients with symptomatic Benign Prostatic Hyperplasia (BPH) undergoing TURP with either 1.5% glycine or sterile water as irrigation fluid. The duration of surgery, weight of prostate resected, volume of fluid absorbed were compared. Post-operative levels of hemoglobin, hematocrit, electrolytes and renal function tests at 15 mins, 3 hrs and 6 hrs were analysed. Results: The mean decrease in hemoglobin at 6 hrs was more with 1.5% glycine (1.05±0.28 vs 0.89±0.14g/dL) and was statistically significant (P = 0.031). The mean fall in haematocrit at 6 hrs was significantly more with 1.5% glycine (4.87±1.41 vs 3.94±1.32%) (P = 0.046). The post-operative levels of blood urea were significantly less with 1.5% glycine at 15 mins, 3 hrs and 6 hrs (P 0.05). Nine patients (30%) who received 1.5% glycine and 8 patients (26.6%) receiving sterile water had dilutional hyponatremia at 6 hrs, but there were no significant difference between the two groups (P = 0.38). None of the patients developed TURP syndrome. Conclusion: Biochemical changes with sterile water was significantly less when compared with 1.5% glycine in TURP. Most of the changes observed were at 6 hrs after surgery. Hence sterile water can be considered as a safer and inexpensive alternative to glycine in resource-limited settings of low-income countries.

Perioperative stroke following transurethral resection of prostate: high index of suspicion and stabilization of physiological parameters can save lives

We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered completely over the next few days without any residual neurological deficit.

Retrospective Review of TURP Done in One Year and Report on Postoperative Outcome

To assess the short-term clinical outcome of transurethral resection of prostate (TURP) at Khwaja Yunus Ali Medical College &amp; Hospital (KYAMCH).This is a retrospective study performed in the urology department of our hospital for a period of one year. For all patients conventional monopolar resection was performed. Glycine was used as irrigant. Usually patients were admitted 1 day before surgery. TURP was performed under spinal anesthesia. All patients received intravenous prophylactic antibiotic. In most patients we have removed indwelling catheter on 2nd postoperative day.In one year, we have performed 45 TURPs. The median age of the patient was 67.0(48-85) years. Most common indication was acute retention of urine (62.2%). Median prostatic volume was 52.3mls on transabdominal ultrasound. The median weight of resected prostatic tissue was 24.25gm (5-60 gms), with a median resection time of 63.5 min. There was no mortality. Five patients (11.1%) received blood transfusion during or immediate post operative period of TURP. No patient develop TURP syndrome, one patient developed post-TURP febrile UTI. No patient developed permanent incontinence in our study.TURP is safe and effective in reducing the symptoms and complications related to benign prostatic hyperplasia .Advances in techniques, instrumentation, surgical and perioperative management, careful selection of patients and early catheter removal policy might increase the efficiency of TURP with acceptable complication rates.KYAMC Journal Vol. 4, No.-1, July 2013, Page 321-325

Electrolyte Changes in Monopolar and Bipolar Transurethral Resection of Prostate (TURP) – A Prospective Randomized Study

Prostatectomy and Transurethral resection of prostate TURP have been the surgical options for men with obstructive symptoms due to benign prostatic hyperplasia. Various clinical manifestations produced due to the absorption of large volumes of irrigating fluid during TURP are referred to as TURP syndrome. In this study we have analyzed the changes in serum electrolytes while using irrigating fluids such as 1.5 glycine and Normal saline while performing TURP using Monopolar and Bipolar procedures respectively. A prospective randomized study was conducted on 88 male patients belonging to the age group of 50 to 86 years over a period of 19 months. 1.5 glycine was used in 46 cases and Normal saline in 42 cases for irrigation. The weight of the prostate gland ranged from 25 gms to 90 gms. The duration of the TURP surgery ranged from 10 min to 90 min. The volume of 1.5 glycine used ranged from 5l litres to 21 l and the volume of normal saline ranged from 5l to 36l. The changes in serum electrolytes that occurred during the procedure were correlated with duration of the procedure volume of 1.5 glycine and Normal saline used and weight of prostate gland resected. The electrolyte changes during Monopolar and Bipolar TURP were same. Use of Normal Saline did not have any advantages over glycine in patients undergoing TURP.

Transurethral resection of prostate syndrome

Transurethral resection of prostate syndrome

Conivaptan prophylactically in transurethral resection of prostate surgeries

Background Transurethral resection of prostate (TURP) requires the use of irrigating fluids. The absorption of large volumes of these fluids may lead to hyponatremia and consequently TURP syndrome. If not treated promptly, the patient becomes cyanotic, hypotensive, and ultimately sustains cardiac arrest. Conivaptan is one of vaptans, a new group of vasopressin receptor antagonists that are increasingly being used for the treatment of euvolemic, hypervolemic forms of hyponatremia especially in the ICU. This study evaluates the efficacy of a single dose of conivaptan to prevent hyponatremia in TURP patients. Patients and methods In a prospective, randomized, double-blinded study, 50 male patients scheduled for elective TURP under central neuraxial block were included in this study. Patients were divided into two groups (A and B) (n=25 for each group). Group A patients received intravenous conivaptan 20 mg over 30 min, whereas group B was the control group who received the usual maintenance fluid. Preoperative serum sodium and potassium levels in patients were measured, followed by intraoperative levels, and these levels were recorded after 60 min by blood gas analyzer using venous blood samples. All patients were carefully observed for the early symptoms of TURP syndrome perioperatively. The serum levels of sodium and potassium of all patients were measured 1 h after surgery. Results The mean level of serum sodium showed statistically significant reduction (hyponatremia) intraoperatively and postoperatively in group B. There was a statistically insignificant increase in the mean level of serum potassium (hyperkalemia) intraoperatively and postoperatively in both groups. Electrolyte changes were asymptomatic clinically. Conclusion A single dose of conivaptan was found to be effective in preventing a marked decrease in the serum sodium levels in patients undergoing TURP with no effect on the serum potassium level.

Transient vision loss in transurethral resection of prostate syndrome

We had an unusual experience of patient developing transient loss of vision following transurethral resection of prostate. Various pathophysiological changes contributing the vision loss during transurethral resection of the prostate has been discussed. The patient recovered his vision fully after therapeutic interventions. This paper discusses the possible etiologies for the transient vision loss and treatment of same.

Comparison of intrathecal bupivacaine with or without fentanyl for urosurgeries

Introduction: Spinal anaesthesia has been widely used for urological operations because it permits early recognition of symptoms caused by overhydration, transurethral resection of prostate syndrome and bladder perforation. Short acting spinal anaesthesia may help to prevent complications associated with delayed immobilization. Our study was undertaken to examine whether adding 25?g fentanyl to bupivacaine would intensify sensory and motor block without prolonging recovery time.Materials and Methods: Ninety American Society of Anaesthesiologists physical status I and II scheduled for elective urological procedures were studied in a double-blinded, randomized prospective manner. Random allocation was done as , Group I (n=30) receiving intrathecal bupivacaine 12.5 mg; Group II (n=30) bupivacaine 10 mg with 25 ?g of fentanyl; and Group III (n=30), bupivacaine 5 mg with 25 ?g of fentanyl. Assessment of sensory, motor block and duration of sensory analgesia was done.Result: There was statistically significant difference regarding total duration of motor block, time for two-segment regression and duration of sensory analgesia between each pair of groups. The duration of motor block, time for two segment regression and duration of sensory analgesia was found to be longest in Group II and shortest in Group III. There were no significant differences in the incidence of complications.Conclusion: Addition of 25 ?g fentanyl to 5 mg bupivacaine resulted in short-acting motor block whereas with 10 mg of bupivacaine, it increased the intensity and duration of motor block, prolonged sensory analgesia and two segment regression time.Journal of Society of Anesthesiologists 2014 1(1): 18-21