[Coma during transurethral resection of the prostate]

Area of Science:

• Urology
• Anesthesiology
• Nephrology

Background:

• Transurethral resection of the prostate (TURP) is a common procedure for benign prostatic hyperplasia.
• Complications during TURP, though rare, can be severe and require prompt recognition.
• The use of irrigating solutions like 1.5% glycine can lead to systemic absorption.

Observation:

• Two elderly male patients developed coma during TURP, with Glasgow Coma Scale scores of 9 and 8.
• Coma onset occurred 90 and 120 minutes post-procedure initiation, without preceding hemodynamic instability.
• Complications included urethral catheter blockage and prostatic capsule rupture with peritoneal fluid extravasation.

Findings:

• Acute hyponatremia (128 and 123 mmol/L) and glycine toxicity (10,188 and 11,840 mmol/L) were implicated in the comatose state.
• The specific mechanisms involved severe electrolyte imbalance and potential neurotoxicity from absorbed glycine.
• These events highlight the risks associated with TURP, particularly fluid absorption and electrolyte disturbances.

Implications:

• Regional anesthesia techniques are recommended for TURP to facilitate early diagnosis of complications.
• Prompt surgical intervention and management of electrolyte disturbances are critical for patient recovery.
• This case series emphasizes the importance of vigilant monitoring during TURP to prevent severe neurological complications.