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TURP syndrome

Benign prostatic hyperplasia is one of the most common benign tumors in men. Etiology of this condition is thought to be linked to hormonal imbalance and its prevalence increases with age. If pharmacotherapy fails, a surgical procedure is the next therapeutic step, most often a transurethral resection of the prostate (TURP). TURP syndrome is a serious and life-threatening complication of transurethral resection of the prostate. This algorithm aims to familiarize the solver with the pathophysiology, onset risk factors, clinical signs, diagnosis and treatment of this syndrome. At the end of this algorithm the solver should be aware that TURP syndrome can develop both during and after an uncomplicated TURP procedure.

Jitka Kotolová, Petrana Relovská, Soňa Řezníčková, Kateřina Popková

Benign prostatic hyperplasia is one of the most common benign tumors in men. Etiology of this condition is thought to be linked to hormonal imbalance and its prevalence increases with age. If pharmacotherapy fails, a surgical procedure is the next therapeutic step, most often a transurethral resection of the prostate (TURP). TURP syndrome is a serious and life-threatening complication of transurethral resection of the prostate. This algorithm aims to familiarize the solver with the pathophysiology, onset risk factors, clinical signs, diagnosis and treatment of this syndrome. At the end of this algorithm the solver should be aware that TURP syndrome can develop both during and after an uncomplicated TURP procedure.

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Keywords: TURP syndrome, transurethral resection of prostate, benign prostatic hyperplasia, LUTS, hemodialysis, prostatic venous plexus, osmolality, hyponatremia, osmotic demyelination syndrome

Review

This training algorithm aptly describes the ongoing diagnosis and decision-making process of treatment of this life-threatening complication of transurethral resection of the prostate. It correctly emphasizes the importance of recognition and early initiation of appropriate therapy for this previously often fatal syndrome. Nowadays, thanks to the progress in surgical techniques and patient monitoring, its occurrence is much rarer so it is even more important to think about it and react immediately. The decision algorithm is logical, in addition to the correct management, it also indicates the most common mistakes and incorrect procedures that can cost the patient his life in this peracutely occurring disease. This model example is very close to a real situation that must be properly handled by every medical doctor in anesthesiology and intensive care medicine. Practicing the right course of action is the best preparation for the real situation. Unlike a teaching algorithm, it is often not possible to "take a step back" in real life.

created: 9. 8. 2021 | last modified on: 1. 10. 2021


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