[The TUR syndrome]

Abstract

The incidence rate of transurethral resection (TUR) syndrome ranges from 1 to 7 percent, although the mild cases may reach up to 10.25 per cent. Irrigation using nonelectrolyte fluid is associated with absorption of the latter. The prompt penetration of more than one liter distilled water into the circulation becomes manifest with a diversity of cardiovascular and neurological symptoms. In the event of persisting hypotension with bradycardia, the acute forms of TUR syndrome may result in a fatal outcome. The essence of TUR syndrome necessitates the undertaking of competent treatment, carried out by a team of specialists, including, apart from urologist and anesthesiologist, an intensive care therapist, neurologist, cardiologist, ophthalmologist and laboratory physician. In addition to general supporting treatment, it is mandatory to combat hypotension, hyponatremia, hypoosmolality and anuria. Monitoring the amount of fluid being absorbed has important practical implications on the prophylaxis. For the purpose ethanol (1 percent) as indicator is added to the wash-out fluid. By its concentration in the air exhaled by the patient it is possible to measure the quantity of fluid intake. In the survey presented the detrimental effects of glycine--the commonest osmotically active constituent of the wash-out fluid--is also discussed.