Rais Lamia, El Ati Zohra, Ben Fatma Lilia, Kheder Rania, Jebali Hela, Smaoui Wided, Krid Madiha, Ben Hamida Fethi, Ben Moussa Fatma, Beji Soumaya, Zouaghi Mohamed Karim
Tunis Med. 2017 Feb;95(2):139-141.
Transurethral resection of the prostate is currently the gold standard for the surgical treatment of the benign prostatic hyperplasia. This surgery may lead transurethral resection of the prostate (TURP) syndrome and in some cases, acute tubular necrosis can develop. We report a patient who developed hyponatremia, hemolysis and oliguric acute renal failure as a major complication following TURP using glycine as irrigating fluid.A 64-year-old man was admitted for a prostate resection procedure. Physical examination revealed a healthy elderly man. Preoperative laboratory data showed serum sodium 140 mEq/L, blood urea nitrogen (BUN) 0.6 g/L, creatinine 0.7 mg/dL and hemoglobin 12.9 g/dL. Few hours after, the patient becomes incoherent and developed oliguria, nausea and vomiting. The laboratory data revealed rapidly elevating BUN and creatinine levels (BUN 2.4 g/L; creatinine 6.1 mg/dL), the serum sodium concentration decreased by 14 meq/L. A decreased hemoglobin level (7.4 g/dL) with an elevated lactate dehydrogenase level (665 U/L) was observed. Renal ultrasonography was normal. The diagnosis of acute tubular necrosis complicating TURP syndrome was retained. The hyponatremia was slowly corrected to 132 mmol/L by diuresis and fluid restriction. The renal function recovered after four hemodialysis sessions. Using glycine as an irrigant for TURP may cause hyponatremia, hemolysis and also acute renal failure, especially in patients with longer resection time. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.
经尿道前列腺切除术目前是良性前列腺增生手术治疗的金标准。该手术可能导致经尿道前列腺电切术（TURP）综合征，在某些情况下，还会发展为急性肾小管坏死。我们报告一例患者，在使用甘氨酸作为冲洗液进行经尿道前列腺电切术后，出现低钠血症、溶血和少尿性急性肾衰竭等主要并发症。
一名64岁男性因前列腺切除术入院。体格检查显示该老年男性身体健康。术前实验室数据显示血清钠140 mEq/L，血尿素氮（BUN）0.6 g/L，肌酐0.7 mg/dL，血红蛋白12.9 g/dL。数小时后，患者出现意识不清，并出现少尿、恶心和呕吐。实验室数据显示血尿素氮和肌酐水平迅速升高（血尿素氮2.4 g/L；肌酐6.1 mg/dL），血清钠浓度下降了14 mEq/L。观察到血红蛋白水平降低（7.4 g/dL），乳酸脱氢酶水平升高（665 U/L）。肾脏超声检查正常。诊断为并发TURP综合征的急性肾小管坏死。通过利尿和限制液体摄入，低钠血症缓慢纠正至132 mmol/L。经过四次血液透析后肾功能恢复。使用甘氨酸作为经尿道前列腺电切术的冲洗液可能会导致低钠血症、溶血以及急性肾衰竭，尤其是在手术时间较长的患者中。必须尽一切努力缩短手术时间并避免手术期间的外渗。
