Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century.

OBJECTIVES: To evaluate the risk of hyponatremia and transurethral resection of the prostate (TURP) syndrome after bipolar saline TURP in patients with large-volume, benign prostatic hyperplasia and statistically significant comorbidities.

METHODS: Five patients with large symptomatic benign prostatic hyperplasia and significant comorbidities underwent saline TURP. Data were collected regarding patient profile, prostate weight, operative time, and perioperative events. In particular, we studied and compared the preoperative and postoperative serum sodium concentrations and hematocrit.

RESULTS: The mean age was 68 years (range 57 to 76). The mean resection weight of the prostatic chips was 49.6 g (range 37 to 62). Senior urology residents under the supervision of the university faculty performed all procedures. The average operative time was 2 hours, 22 minutes (range 98 to 175 minutes). The mean serum sodium concentration decreased by 1.6 mg/dL (from 138.4 mg/dL preoperatively to 136.8 mg/dL postoperatively). The mean hematocrit decreased by 5.60% (from 40.24% preoperatively to 34.64% postoperatively). Postoperative recovery was uneventful in all 5 patients.

CONCLUSIONS: Bipolar saline TURP is safe and eliminates the risk of TURP syndrome in high-risk patients with large prostates that require lengthy resection. In addition, the system permits the faculty to spend the time needed for teaching and training urology residents without compromising patient safety.