Complications after transurethral surgery

Frequency and types of complications

Transurethral operations (TURP, transurethral resection of the prostate, and transurethral resection of the bladder) are invasive procedures with a risk of complications.

Complications:

• Bleeding (early and delayed).
• Perforation (capsular, intraperitoneal).
• TUR syndrome (fluid overload, hyponatremia).
• Infection (cystitis, pyelonephritis, sepsis).
• Urethral stricture.
• Urinary incontinence.
• Erectile dysfunction.

Clinical assessment

• Bleeding: hematuria, clot retention, hypotension.
• Perforation: pain, peritoneal signs, urine leakage.
• TUR syndrome: nausea, vomiting, confusion, hyponatremia.
• Infection: fever, rigors, pain.
• Stricture: reduced urinary flow, retention.

Diagnosis

• Assess hemodynamics and electrolytes (Na).
• Ultrasonography for hydronephrosis and perforation.
• Cystography if perforation is suspected.
• Uroflowmetry at a later stage.

Emergency management

• Bleeding: three-way catheter → irrigation → cystoscopy if unsuccessful.
• Perforation: catheterization for a small perforation or surgery for a large one.
• TUR syndrome: immediately stop the procedure and irrigation fluid delivery; stabilize ABC, measure sodium, osmolality, and blood gases, and assess neurological status. For severe neurological symptoms, give a bolus of 3% NaCl according to the local protocol, with frequent sodium monitoring and limits on the rate of correction. Use a loop diuretic only for confirmed volume overload or pulmonary edema.
• Infection: antibiotics and drainage if obstruction is present.
• Stricture: urethrotomy or dilatation at a later stage.

Algorithm