Ann Clin Case Rep | Volume 3, Issue 1 | Case Series | Open Access

Volumetric Overload Shocks (VOS) Causing the Transurethral Resection of the Prostate (TURP) Syndrome: Case Reports

Khalid A Ghanem1, Nisha Pindoria2, Salma A Ghanem3 and Ahmed N Ghanem4*

1Mansoura University Hospital, Egypt
2North Middlesex University Hospital Sterling Way, London
3Barts & the Royal London NHS Trust, Royal London Hospital, London
4Consultant Urologist Surgeon, Egypt

*Correspondance to: Ahmed N Ghanem 

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Introduction and
Objective: The TURP syndrome complicates 1.5% glycine absorption during the TURP procedure. It presents as vascular shock previously reported as hyponatraemic shock. However, it is commonly mistaken for haemorrhagic or septicaemic shock and is treated with volume expansion causing lethal outcome. The first two case reports reported here represent this practice. The remaining two cases report the concept of VOS causing TURP syndrome and the life saving treatment of Hypertonic Sodium Therapy (HST).Patient and
Methods: Four case reports are presented. Two represent the old school of thinking using volume expansion for treatment of TURP syndrome with lethal outcome. Two cases represent the modern school advancing the concept of VOS for the patho-etiology of TURP syndrome and using HST for treatment.Results: The first two cases were mistaken for a recognized shock and treated with volume expansion; both died. The remaining two cases were identified as VOS1 and treated with HST whose lives were saved.Conclusion: The concept of VOS identified in the patho-etiology of the TURP syndrome as VOS1 characterized with acute hyponatraemia allows using HST as life saving therapy. VOS2 is that induced by saline-based fluids and has no such clear marker.


Ghanem KA, Pindoria N, Ghanem SA, Ghanem AN. Volumetric Overload Shocks (VOS) Causing the Transurethral Resection of the Prostate (TURP) Syndrome: Case Reports. Ann Clin Case Rep. 2018; 3: 1551.

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