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TURP Syndrome — FRCA Final MCQ

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ModerateGeneral AnaesthesiaTURP SyndromeFRCA Final

A 70-year-old man (ASA III) is undergoing monopolar transurethral resection of the prostate under spinal anaesthesia. Forty-five minutes after resection begins, he becomes confused and nauseated; his blood pressure is 180/100 mmHg and serum sodium is 118 mmol/L. Which mechanism most likely accounts for this presentation?

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Correct answer: A — Systemic absorption of electrolyte-free irrigation fluid through opened prostatic venous sinuses

This is **TUR syndrome**, caused by rapid systemic absorption of electrolyte-free irrigation fluid through opened prostatic venous sinuses during monopolar resection. Glycine is a traditional non-conductive irrigant. Absorption produces acute intravascular volume expansion and dilutional hyponatraemia; glycine and its metabolites may additionally contribute to encephalopathy and visual disturbance. The abrupt intraoperative confusion, nausea, hypertension and sodium of 118 mmol/L are characteristic. SIADH and adrenal insufficiency can cause hyponatraemia but do not adequately explain this procedure-linked acute volume load. Cerebral salt wasting requires relevant intracranial disease and causes sodium depletion with hypovolaemia. Oral water intoxication is implausible during spinal anaesthesia. Bipolar TURP generally uses isotonic saline and therefore does not produce classic hyponatraemic TUR syndrome, although excessive saline absorption can still cause volume overload and hyperchloraemic acidosis.

Reference: Trauma Surgery & Acute Care Open. Acute severe iatrogenic hyponatremia. 2019. https://rcoa.ac.uk/sites/default/files/documents/2025-05/CRQreport%20Feb25_FINAL.pdf