Occurs with absorption of 2L or more of irrigation fluid via venous sinuses in prostate. Results in Circ. Overload: --Inc BP --Bradycardia --Irrigation fluid solute toxicity --Hyponatremia (dilutional) --HypoOsmolality
Symptoms associated with Hyponatremia
Na: 125mEq/L No symptoms --120 mEq/L Restlessness/ confusion/ wide QRS --115 mEq/L Somnolence/ nausea//wide QRS/ ST elev --110 mEq/L Seizures
What are the S/Sx to watch for with TURP Syndrome
-Cyanosis -Dyspnea -Arrythmias -Dec BP -CHF/ Pulm Edem -Hemolysis
Treatment for TURP syndrome
*Early Recognition *Terminate seizures *Eliminate Absorbed Water: Loop diuretics *Maintain oxygenation and perfusion *Hypertonic Saline(3% or 5%) @ 100cc/hr max
What type of irrigationg solution is most commonly used in TURPS
Solution should be slightly hypotonic and non-electrolyte fluids.... --Glycine 1.5% --Cytal: mix of sorbital 2.7% and mannitol 0.54% (less common: Sorbital 3.3%, Mannitol 3%, Dextrose, urea) Edit
What are the factors that affect solution absorption during a TURP
1. type of solution 2. duration of the resection 3. height of irrigation solution(60cm above is max) 4. pressure of solution administered 5. blood loss Edit
What are the symptoms of glycine Toxicity from TURP
-circulatory depression and CNS toxicity -Inhibitory neurotransmitter in CNS (rare transient blindness) Edit
What are the causes of Bladder perforation of TURP
1. Cutting loop or knife electorde 2. tip of resectoscope 3. Overdistention of the bladder with irrigation fluid. ****Fluid goes in but does not come out!
Symptoms of bladder perforation during TURP
Awake pt: N/V, Diaphoresis, pallor, abd pain Large perforations can cause sudden unexplained hemodynamic changes.
What are the advantages to using an Indigo Laser TURP
Laser "heats" tissue and it is reabsorbed No irrigation Less Painful Quicker Used with ambulatory surgery center.
Where can stones cause obstruction in the GU system