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Complications of TURP

Complications of TURP. 1. Case presentation 2. TURP syndrome 3. Prevention and treatment Ri 陳昭勳. Brief History. 陳 X 傑 63 y/o male Symptoms of urinary frequency and urgency OPD follow-up and controlled by Hytrin. Past History.

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Complications of TURP

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  1. Complications of TURP • 1. Case presentation • 2. TURP syndrome • 3. Prevention and treatment Ri 陳昭勳

  2. Brief History • 陳X傑 63y/o male • Symptoms of urinary frequency and urgency • OPD follow-up and controlled by Hytrin

  3. Past History • Coronary artery disease s/p stenting controlled by Aspirin • Hypertension controlled by Norvasc • ASA Class III

  4. Incidence of systemic dz in TURP patients Disease Incidence % Cardiac disease 67 Cardiovascular 50 COPD 29 DM 8

  5. Brief History • 2 weeks ago difficulty in urination • Foley catheterizations several times • Cystostomy on 91-2-18 DC Tapal • Admission for TURP on 91-2-25

  6. 麻醉過程 • Please see 實物投影機

  7. Irrigation Solution • Ideal: isotonic, electrically inert, nontoxic, transparent, easy to sterilize,inexpensive • Traditional: distilled water • Modern: Glycine (1.2% and 1.5) Mannitol ( 3%) Urea ( 1%)

  8. Definition of TURP syndrome • Following complications have been reported: hypervolemia, hyponatremia, water intoxication, pulmonary edema, hemolysis, caogulopathy, bladder perforation

  9. TURP syndrome: a problem of Volume and Solute • Intravascular volume: volume expansion and volume loss • Plasma solute: hyponatremia hypoosmolality hyperglycinemia Plasma osmolality=2xNa+Glu/18+BUN/2.8

  10. Hyponatremia • Mechanism for hyponatremia in TURP • Na is essential for cerebral and cardiac function • <120 meq/L cardiovascular depression <115meq/L bradycardia,ECG change <100meq/L generalized seizure • Average fall in Na 3.65-10 meq/L • Incidence 7%-26%

  11. Hypoosmolality • Derangement of CNS function due to cerebral edema • Clinical signs: decerebrate posture, positive Babinski sign, low-voltage EEG, comatose

  12. Hemolysis • 30-70% of patients, who use water as irrigation solution • Clinical signs: chills, clammy skin, tight chest, bronchospasm • Oxygen carrying capacity decrease Free hemoglobin increase Hyperkalemia

  13. Bladder Perforation • Caused by instrumentation, overdistension or explosion of hydrogen • Most bladder perforation is retroperitoneal • Clinical signs: return of irrigation solution decrease, abdominal distension

  14. Prevention of TURP syndrome • Surgical technique • 術前矯正electrolyte and fluid imbalance • Special attention to cardiac p’t • Height of irrigation solution bag • Duration of surgery

  15. Treatment of TURP syndrome • Terminate surgery • Administer Lasix • Hypertonic saline (3-5%) for hyponatremia • Intubation for pulmonary edema • Diazepam for seizure

  16. References • Transurethral Resection of the Prostate Syndrome: A Review of the Pathophysiology and Management Anesthesia and Analgesia Feb ’97 438 • Anesthesia for Renal and Genito-Urologic surgery • Complications of Urologic Surgery

  17. Estimation of Fluid Absorption • Serum Sodium Dilution [(Pre-Op Na)/ (Post-op Na) –1] x ECF • Breath-alcohol level • Patient’s weight gain

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