Volumetric overload shocks in the patho-aetiology of the Transurethral Resection of the Prostate (Turp) Syndrome and acute dilution hyponatraemia: The clinical evidence based on prospective clinical study of 100 consecutive Turp patients

Introduction and objective: Circulatory shock affecting patients with the TURP syndrome has frequently been described but has usually been mistaken for hypovolaemic blood loss, cardiogenic or septicaemic shock. Here we report a prospective study that proves the patho-aetiology of the TURP syndrome is induced by volumetric overload. Patients and methods: A prospective study of 100 consecutive patients undergoing TURP was conducted. The volume and type of perand 24-h 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. Results: 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 >20 mmol/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 hypotension and shock, (which we refer to as VOS1); The best treatment for VOS1 of the TURP syndrome is hypertonic 5% NaCl. Correspondence to: Ahmed N. Ghanem, Retired Consultant Urologist, No1 President Mubarak Street, Mansoura 35511, Egypt, Tel: 001020883243; E-mail: [email protected]