Fatal and Forgotten: Acute Hemolytic Anemia and Renal Failure as a Complication of Transurethral resection of the prostate

Transurethral resection of the prostate (TURP) is the most common surgical modality to treat symptomatic benign hypertrophy of the prostate (BPH). The American Urological association (AUA) considers TURP the preferable modality of treatment for symptomatic BPH compared to surgery, as the latter carries a high rate of complications [1]. According to the AUA, in the United States approximately 150,000 people have TURPs performed each year with 88% having immediate improvement in their symptoms. Although TURP represents a declining percentage of primary BPH treatment, annual incidence remains as high as 39% of BPH procedures in 2005 [2]. While TURP is considered minimally invasive and generally has fewer complications than open surgery, widespread use of TURP has revealed some dangerous and even fatal complications. The use of hypotonic bladder irrigants during TURP can lead to acute hypo-osmolar hyponatremia that could be potentially fatal. This complication, also known as TURP syndrome, complicates 0.8-1.2% of TURP [3,4]. A rarely described and potentially fatal complication of TURP is brisk intravascular hemolysis with concomitant secondary acute kidney injury (AKI). To our knowledge, only six cases have reported this finding in the world literature [5-10]. The significant mortality and morbidity associated with this phenomenon merits a more thorough description of TURP syndrome related acute hemolytic anemia.