Dilutional hyponatremia of TURP syndrome: A historical event in the 21st century

Issa, Muta M; Young, Mark R; Bullock, Andrew R; Bouet, Rafael; Petros, John A

doi:10.1016/j.urology.2004.03.023

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Volume 64, Issue 2 , Pages 298-301, August 2004

Dilutional hyponatremia of TURP syndrome: A historical event in the 21st century

Muta M Issa
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
- Reprint requests: Muta M. Issa, M.D., M.B.A., Department of Urology, Emory University School of Medicine, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
Mark R Young
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
Andrew R Bullock
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
Rafael Bouet
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
John A Petros
- Department of Urology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA

Received 5 February 2004; accepted 11 March 2004.

Abstract

Objectives

To evaluate the risk of hyponatremia and transurethral resection of the prostate (TURP) syndrome after bipolar saline TURP in patients with large-volume, benign prostatic hyperplasia and statistically significant comorbidities.

Methods

Five patients with large symptomatic benign prostatic hyperplasia and significant comorbidities underwent saline TURP. Data were collected regarding patient profile, prostate weight, operative time, and perioperative events. In particular, we studied and compared the preoperative and postoperative serum sodium concentrations and hematocrit.

Results

The mean age was 68 years (range 57 to 76). The mean resection weight of the prostatic chips was 49.6 g (range 37 to 62). Senior urology residents under the supervision of the university faculty performed all procedures. The average operative time was 2 hours, 22 minutes (range 98 to 175 minutes). The mean serum sodium concentration decreased by 1.6 mg/dL (from 138.4 mg/dL preoperatively to 136.8 mg/dL postoperatively). The mean hematocrit decreased by 5.60% (from 40.24% preoperatively to 34.64% postoperatively). Postoperative recovery was uneventful in all 5 patients.

Conclusions

Bipolar saline TURP is safe and eliminates the risk of TURP syndrome in high-risk patients with large prostates that require lengthy resection. In addition, the system permits the faculty to spend the time needed for teaching and training urology residents without compromising patient safety.