Urology: TURP syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Urology: TURP syndrome

Sample item

A 68-year-old man has a 90-minute transurethral resection of the prostate under spinal anaesthesia with glycine irrigation. In recovery he becomes confused and nauseated, with blurred vision, bradycardia and hypertension. Serum sodium is 108 mmol/L. What is the cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Absorption of hypotonic irrigation fluid causing dilutional hyponatraemia

During TURP, irrigation fluid can be absorbed through open prostatic venous sinuses, causing volume overload and dilutional hyponatraemia, which is called TURP syndrome. Features include confusion, nausea, visual disturbance (glycine), hypertension with bradycardia and seizures. Management is to stop the procedure, give oxygen and loop diuretic, and cautiously correct sodium with hypertonic saline in severe cases. Risk rises with resection over 60 to 90 minutes and high irrigation pressure.

Option by option

  • A. Septicaemia from bacteraemia during resection

    Septicaemia causes fever, tachycardia and hypotension, not hypertension with bradycardia.

  • B. Local anaesthetic toxicity from the spinal block

    Spinal anaesthetic toxicity does not cause hyponatraemia, and its effects appear with the block.

  • C. Bladder perforation with intraperitoneal extravasation

    Perforation would cause abdominal pain and distension, and the sodium would not fall this far.

  • D. Absorption of hypotonic irrigation fluid causing dilutional hyponatraemia (correct)

    Fluid absorption lowers serum sodium and produces the characteristic neurological picture.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Absorption of hypotonic irrigation fluid causing dilutional hyponatraemia. During TURP, irrigation fluid can be absorbed through open prostatic venous sinuses, causing volume overload and dilutional hyponatraemia, which is called TURP syndrome.

Why is "Septicaemia from bacteraemia during resection" not the answer?

Septicaemia causes fever, tachycardia and hypotension, not hypertension with bradycardia.

Why is "Local anaesthetic toxicity from the spinal block" not the answer?

Spinal anaesthetic toxicity does not cause hyponatraemia, and its effects appear with the block.

Why is "Bladder perforation with intraperitoneal extravasation" not the answer?

Perforation would cause abdominal pain and distension, and the sodium would not fall this far.

What concept does this question test?

It tests Urology: TURP syndrome in General Surgery. Features include confusion, nausea, visual disturbance (glycine), hypertension with bradycardia and seizures. Management is to stop the procedure, give oxygen and loop diuretic, and cautiously correct sodium with hypertonic saline in severe cases. Risk rises with resection over 60 to 90 minutes and high irrigation pressure.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: TURP syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.