Transurethral Resection of the Prostate and Anesthesia

Abstract

Beningn prostatic hypertrophy frequently leads to symptomatic bladder outlet obstruction in men over 60 years of age. Patients undergoing transurethral resection of the prostate (TURP) should be carefully evaluated for coexistent cardiac and pulmonary disease. Either spinal or epidural anesthesia involving T10 sensory level provides anesthesia and good operating conditions for TURP. When compared with general anesthesia, regional anesthesia appears to reduce the incidence of postoperative venous thrombosis. It is also less likely for regional anesthesia to mask symptoms and signs of the TURP syndrome or bladder perforation. Various perioperative complications have been reported in TURP patients including pulmonary edema, water intoxication, hyponatremia, glycine and ammonia toxicity, hypovolemia, visual disturbances, hemolysis, coagulapothies, sepsis and toxemia, bladder perforation and rupture. The TURP syndrome can occur as early as a few minutes after surgery has started and as late as several hours after surgery. The blood pressure rises (both systolic and diastolic) and the heart rate decreases. TURP irrigation solutions are either isotonic or nearly isotonic, electrically inert, non-toxic and transparent. Irrigating solutions should be warmed to body temperature prior to use to prevent hypothermia. Absorption of irrigation fluid appears to be depent on the duration of the resection as well as the pressure of the irrigation fluid. Treatment of TURP syndrome depends on early recognition and should be based on the severity of symptoms.