Summary

Patients and methods: A prospective study of 100 consecutive patients undergoing TURP was conducted. The volume and type of per- and 24h post-operative intravenous fluids infused were recorded and the volumes of glycine absorbed and blood loss were measured. Serum changes in solute contents were also measured before, after and 24h after the surgery. Blood and urine cultures were done on all symptomatic patients.

Result: The mean per-operative volume of glycine absorbed, total fluid gained and blood loss were 0.6(SD±0.7), 1.57(±0.98) and 0.356(±0.148) litres, respectively. Fifty nine patients absorbed 0-1 litre, 20 absorbed 1-1.5 and 12 absorbed >1.5 litres of glycine. A total of 20, 10 and 4% of all patients showed a drop in post-operative serum sodium concentration of >10, >15 and >20mmol/l respectively. Ten patients fulfilled the criteria of the TURP syndrome manifesting with hypotension shock with bradycardia. Volumetric overload proved to be the only significant factor in causing the TURP syndrome. A significant relationship between the post-operative drop in serum sodium concentration and total volumetric gain of 3.54(±0.6) litres, including IVI fluids, was observed (P=0.0001). Hypertonic 5% NaCl proved effective in treating volumetric overload shocks of the TURP syndrome. Those treated with hypertonic sodium responded promptly and recovered fully passing between 2.5 and 4.5 litres of urine.

Conclusion:The results of this study have shown that the TURP syndrome is precipitated by sodium-free fluid volumetric overload, the result of glycine absorption and intravenously infused fluids. A volume of 3.5 litres induces VOS1. The best treatment for VOS1 of the TURP syndrome is hypertonic 5% NaCl.

Keywords: Shock; Hyponatraemia; The transurethral resection of the prostate (TURP) syndrome; The adult respiratory distress syndrome (ARDS); Prospective study; Hypertonic sodium

Abbreviations: TURP: The Transurethral Resection of the Prostate; ARDS: The Adult Respiratory Distress Syndrome; HN: Hyponatraemia; VOS: Volumetric Overload Shock; MVOD: The Multiple Vital Organs Dysfunction; SD: Standard Deviation; Hb: Haemoglobin; PCV: Packed Cell Volume; WCC: White Cell Count; IVI: Intravenously Infused