A 70-year-old man undergoes TURP for benign prostatic hyperplasia. Postoperatively he develops confusion, bradycardia, and hyponatraemia with serum sodium of 118 mEq/L. The irrigating fluid most likely responsible for this complication when used in monopolar TURP is:

• A Normal saline 0.9%
• B 5% dextrose in water
• C Distilled water
• D 1.5% glycine solution ✓

Explanation

TURP syndrome results from systemic absorption of hypotonic irrigating fluid through opened prostatic venous sinuses during monopolar TURP. Glycine 1.5% is the standard irrigant for monopolar TURP because it is non-electrolyte (prevents current dispersion), nearly iso-osmolar, and does not haemolyse red cells. When absorbed in large amounts, it causes dilutional hyponatraemia, neurological symptoms (confusion, visual disturbances from glycine's inhibitory neurotransmitter effects), and cardiovascular depression. Normal saline cannot be used with monopolar TURP as it disperses current. Bipolar TURP can use saline, avoiding TURP syndrome.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.