SHM Converge Scientific Abstract ePoster Gallery-Out of Equilibrium: Recognizing Post-Transurethral Resection of the Prostate Syndrome

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This case report describes <strong>TURP syndrome</strong>, a rare but serious complication of <strong>transurethral resection of the prostate (TURP)</strong>, the standard surgical treatment for symptomatic benign prostatic hyperplasia when medications fail. Although perioperative complications are uncommon, prolonged procedures that require large amounts of irrigation fluid can lead to dangerous absorption of fluid and solutes.

A <strong>78-year-old man</strong> underwent elective TURP using <strong>1.5% glycine irrigation</strong>, with about <strong>33 liters</strong> of fluid used. In recovery, he had <strong>difficulty awakening</strong>, <strong>new sinus bradycardia</strong>, lethargy, altered mental status, and incoherent speech. Labs showed <strong>severe hyponatremia</strong> (Na 103 mmol/L), <strong>hyperkalemia</strong> (K 5.7 mmol/L), <strong>hyperammonemia</strong>, and <strong>metabolic acidosis</strong> (pH 7.27, bicarbonate 12 mmol/L). These findings were attributed to <strong>TURP syndrome</strong>, caused by rapid absorption of irrigation fluid through disrupted prostatic blood vessels. In this case, glycine irrigation also contributed to <strong>glycine toxicity</strong> and ammonia accumulation.

The patient was transferred to the ICU and treated with <strong>two 100-mL boluses of 3% hypertonic saline</strong> for sodium correction, along with <strong>intermittent hemodialysis</strong> to remove excess volume and toxic metabolites. His condition improved over the next 24 hours, and he was discharged on postoperative day 4 in his baseline state of health.

The report emphasizes that clinicians should suspect TURP syndrome in <strong>longer TURP procedures with high irrigation volumes</strong>, especially when postoperative neurologic changes or arrhythmias occur. Prevention focuses on minimizing operative time and limiting fluid absorption. Prompt recognition and treatment are essential to prevent fatal outcomes.

Asset Subtitle

Ajith Thomas

Meta Tag

Author List Ajith Thomas, Ghaleb Khirfan

Category Clinical Vignettes

Concept Transurethral Resection of the Prostate

Concept TURP Syndrome

Concept Dilutional Hyponatremia

Concept Hyponatremia

Concept Benign Prostatic Hyperplasia

Distinguished Non-Finalist

Presenter Organization Corewell Health West

Presenting Author Ajith Thomas

Track Adult

Keywords

TURP syndrome

transurethral resection of the prostate

benign prostatic hyperplasia

glycine irrigation

hyponatremia

hyperkalemia

hyperammonemia

metabolic acidosis

hypertonic saline

hemodialysis

Transurethral Resection of the Prostate

TURP Syndrome

Dilutional Hyponatremia

Hyponatremia

Benign Prostatic Hyperplasia