Irrigation Fluid Management in Transurethral Resection of the Prostate

Procedure Variables and Fluid Requirements

Bipolar TURP generally requires similar irrigation volumes to monopolar TURP, but with potentially lower absorption risks, according to the European Urology guidelines 1, 2
Bipolar TURP has a more favorable perioperative safety profile than monopolar TURP, partly due to different irrigation fluid requirements, as stated by the European Urology guidelines 2

The American College of Surgeons recommends maintaining crystalloid administration at 1-4 ml/kg/hr as maintenance fluid during TURP procedures, with goal-directed fluid boluses for patients developing intravascular volume deficits 3
Regular monitoring of vital signs, urine output, and fluid balance is essential during the procedure, and consider more advanced hemodynamic monitoring for longer procedures or higher-risk patients, as suggested by the medical guidelines 3
Avoid excessive fluid administration, as this can lead to fluid overload and pulmonary edema, especially in patients with cardiac or renal comorbidities, according to the medical guidelines 3

Balanced crystalloid solutions, such as lactated Ringer's, are more physiological than 0.9% sodium chloride and help avoid hyperchloremic metabolic acidosis, as supported by the European Society for Clinical Nutrition, with a moderate quality of evidence 4

Bipolar TURP has a more favorable perioperative safety profile than monopolar TURP, partly due to different irrigation fluid requirements, but maintenance fluid recommendations remain the same, according to the European Association of Urology 5

TUR syndrome, although less common with bipolar TURP, still requires monitoring for signs of hyponatremia, confusion, and cardiovascular instability, as recommended by the European Association of Urology 5