Transurethral resection syndrome—it does not have to be a mystery - Home Study Program - Brief Article

AORN Journal,  Jan, 2002  by Ann Chambers

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The article "Transurethral resection syndrome--It does not have to be a mystery" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 2.5 contact hours for this independent study. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Jan 31, 2005.

Send the completed application form, multiple-choice examination, learner evaluation, and appropriate fee to

AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711
or fax the information with a credit card number to (303) 750-3212.

BEHAVIORAL OBJECTIVES

After reading and studying the article on transurethral resection (TUR) syndrome, the nurse will be able to

(1) identify the implications of benign prostatic hypertrophy (BPH) for the male population,

(2) identify alternative therapies for symptomatic BPH

(3) describe transurethral resection of the prostate (TURP),

(4) discuss the goals of treatment for TUR syndrome, and

(5) describe perioperative nursing care for the patient undergoing a TURP procedure.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

A perioperative nurse has just completed a transurethral resection of the prostate (TURP) procedure that lasted almost two hours. The procedure progressed without problems. The patient's vital signs remained stable, and blood loss was less than 500 mL. After emergence from general anesthesia, the patient does not recognize where he is and does not remember that he was having surgery, despite the nurse's best efforts to reorient him. He complains of general malaise, including headache and nausea. What has happened to this patient? What can the perioperative nurse do about it?

The patient described is suffering a complication of TURP termed transurethral resection (TUR) syndrome. This syndrome results from water intoxication of the body, which leads to hyponatremia and other acid-base imbalances. This complication occurs in approximately 2% of all patients undergoing TURP procedures. (1) It is vital for perioperative nurses to understand the factors and dynamics contributing to the development of TUR syndrome, as well as its signs and symptoms, so nursing actions can be taken to identify this complication early or prevent its onset entirely.

ANATOMY AND PHYSIOLOGY

The prostate gland surrounds the urethra at the base of the bladder in men (Figure 1). It is the size of a chestnut, and it normally measures approximately 2 cm x 4 cm. (2) The prostate gland is composed of a fibrous capsule surrounding the musculofibrous glandular tissue. Inside the gland, multiple follicle pouches join to form excretory ducts, which empty into the urethra. These follicle pouches make up a network that is supported by the musculofibrous tissue of the gland and surrounded by a vascular network of capillaries. This vascular network is referred to as a vascular sinus. Although distinct lobes are not visible, the prostate is described in terms of

* right and left lateral lobes,

* the anterior lobe,

* the subcervical lobe, and

* the median lobe. (3)

[FIGURE 1 OMITTED]

The urethra and the ejaculatory ducts penetrate the prostate gland. The ejaculatory ducts pass through the posterior portion of the gland and exit into the prostatic urethra at the verumontanum. These ducts carry the secretions produced by the seminal vesicle and the vas deferens. The secretion of the prostate mixes with that of the ejaculatory ducts during ejaculation. This prostatic secretion is essential to the reproductive process. It is an opaque, alkaline fluid that preserves and mobilizes sperm. The prostate excretes this fluid into the urethra when semen is emitted by the seminal vesicles, adding needed alkalinity, volume, and nourishment for the sperm. (4)

The verumontanum, which is seen as an elevation in the urethra, serves as the most distal landmark of the prostate during TURP procedures. Other landmarks used to guide resection are the right and left ureteral orifices and the bladder neck. The prostate tissue to be resected lies between the verumontanum and the bladder neck. The openings to the ureters are identified during surgery to ensure that they do not become involved in the resection.

Pathophysiology. After 30 years of age, it is normal for a man's prostate to enlarge. Some believe that the release of testicular androgens (ie, testosterone, dihydrotestosterone) increases with age and that these androgens may cause the glandular tissue of the prostate to proliferate. This belief is supported by the finding that men who are castrated to prevent reproduction do not develop hypertrophy of the prostate gland. (5) Enlargement of the prostate is referred to as benign prostatic hypertrophy (BPH) or hyperplasia.