Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management.

W henever irrigation fluid enters the intravascular space, dangerous complications can arise. This is best described as the transurethral resection of the prostate (TURF’) syndrome. The syndrome has also been reported after endometrial ablation (l-5) and ureteroscopic procedures with irrigating solutions (6-8). TURF’ syndrome may occur as quickly as 15 minutes after resection starts (9-ll), or up to 24 hours postoperatively (12). Of approximately 400,000 TURP procedures each year (13), 10% to 15% incur TURP syndrome (14,15) and the mortality is 0.2% to 0.8% (16,17). TURP syndrome affects many systems and manifests itself mainly through acute changes in intravascular volume and plasma solute concentrations (Figure 1). Despite this seemingly consistent etiology, TURP syndrome lacks a stereotypical presentation; therefore, its diagnosis is difficult (Table 1) (14,18-23). Further, recent work suggests that the conventional perioperative management of both TURP and the TURP syndrome may have to be revised.