Severe TURP Syndrome Following Glycine Irrigation: An Anesthetic Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Transurethral resection of the prostate (TURP) syndrome is a life-threatening complication resulting from high-volume absorption of hypotonic irrigation fluid through opened prostatic venous sinuses during surgery. This results in acute dilutional hyponatremia accompanied by neurotoxic and cardiotoxic effects related to hyperammonemia and myocardial strain. Although incidence of the syndrome has declined substantially following the development of bipolar and laser techniques allowing for use of isotonic saline, modern cases have occurred in settings where hypotonic irrigation is used, particularly in patients with risk factors including large prostate size, prolonged operation duration, and cardiovascular comorbidities. For this reason, continued education of perioperative signs and early intervention is still critical for reducing iatrogenic mortality during TURP.

A 78-year-old male with benign prostatic hyperplasia underwent monopolar TURP under general anesthesia. His medical history was significant for chronic kidney disease and congestive heart failure. Procedural risk factors included a large prostate, anticipated prolonged resection time, and planned use of 1.5% glycine irrigation fluid, increasing concern for TURP syndrome. These factors prompted placement of a radial arterial line prior to induction for close continuous blood pressure monitoring and frequent laboratory assessments. The procedure lasted 101 minutes with 60 grams of prostate resected. Intraoperative bradycardia and widening of QRS complexes raised concern for evolving TURP syndrome. In the post-anesthesia care unit, the patient exhibited delayed emergence and altered mental status following extubation. Laboratory evaluation revealed serum sodium level was 103 mmol/L, decreased from a preoperative value of 142 mmol/L obtained five days before surgery.

Although TURP syndrome is now uncommon in modern urologic practice, severe presentations may still occur when glycine-containing irrigation fluids are used. This case highlights the importance of preoperative risk stratification, awareness of irrigation fluid choice, and proactive anesthetic planning, including invasive monitoring. Despite its rarity, TURP syndrome remains a real, observable, and preventable intraoperative emergency, and early recognition with prompt treatment can be life-saving.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1991

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