Transurethral resection of the prostate





L Transurethral resection of the prostate




1. Introduction

Transurethral resection of the prostate (TURP) is one of the most commonly performed surgical procedures in men older than 60 years of age. These patients are often at greater anesthetic risk because they are more likely to have cardiovascular or pulmonary problems. The procedure consists of opening the outlet channel from the bladder with the use of a resectoscope in the urethra for electrically cutting away the obstructing median and lateral lobes of prostate tissue. Bleeding is controlled with a coagulation current. For visualization of the surgical field continuous irrigation is used to wash away blood and dissected prostatic tissue and to distend the bladder.


Various types of irrigating fluid have been used. Although distilled water is associated with the least optical impairment, hemolysis of red blood cells is an unacceptable side effect. Normal saline or lactated Ringer solution is highly ionized and promotes dispersion of high current from the resectoscope. For these reasons, irrigating solutions typically consist of sorbitol (2.70 g) and mannitol (0.54 g) in 100 mL of water (Cytal) or glycine 1.5%. Glycine is slightly hypoosmolar to the blood but is used widely because of its low cost. Average features of a TURP are listed in the following table.



Average Parameters with a TURP
























Parameter Average
Resection time <77 min
Resectate mass 20-48 g
Absorbed volume 1 L
Blood loss 175-534 mL
Speed of TURP syndrome onset 15 min
Serum sodium nadir 132-135 mmol/L

Adapted from Gravenstein D, Hahn RG. TURP syndrome. In Lobato EB, Gravenstein N, Kirby, RR, et al, eds. Complications of Anesthesiology. Philadelphia: Lippincott Williams & Wilkins; 2008: 474-491.




2. Anesthetic technique
a) Spinal anesthesia and general anesthesia have both been used for TURP procedures. Some clinicians believe that spinal anesthesia is ideal because the signs and symptoms of hypervolemia and bladder perforation are more easily detected. A T10 sensory level is necessary for adequate anesthesia. There is no consensus as to the superiority of either technique.

b) Although general anesthesia may mask early complications, it may be desirable in select patients who need pulmonary support or cannot tolerate a fluid load for compensation of a loss of sympathetic tone or when other contraindications to spinal anesthesia exist.

c) Some key points for anesthesia management of TURP are listed in the following box.

 



Key Points for Anesthesia Management of Transurethral Resection of the Prostate




• TURP syndrome is caused by disturbance of intravascular volume or serum osmolality.

• Four questions to ask before a TURP:
1. What is the irrigation fluid?

2. What is the bag height over the prostate?

3. What type of resectoscope is being used?

4. In what mode is the resectoscope being used?

• Techniques for detection of pending TURP syndrome include measurement of serum sodium, measurement of breath alcohol levels by inserting 1% ethanol in the irrigating solution, and volumetric fluid balance.

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Transurethral resection of the prostate

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