Prostatic surgery associated acute kidney injury

Table 3 Suggestions for the prevention and management of transurethral resection of prostate syndrome

Preoperative

Estimate GFR using the CKD-EPI equation

Identify patient risk factors: large prostate gland (> 45 g), heart disease, CKD, and smoking

Advise bipolar TURP or laser techniques for high-risk patients

Intraoperative

Avoid D.W. and glycine as irrigating fluids. Sorbitol and mannitol are good options. Physiologic saline is a safe choice when feasible

Maintain low-pressure irrigation

Consider the use of intra-prostatic vasopressin injection in high-risk patients

Alert surgical team when surgery exceeds one hour

Monitor the volume of absorbed fluid. Consider aborting the procedure if the absorbed volume exceeds 1.0 L and suspend surgery if absorbed volume exceeds 2000 mL

Both spinal and general anesthesia are adequate

Avoid hypotension and central venous pressure reduction and closely monitor the vital signs

Post-operative

Assess serum sodium and serum creatinine in all patients in the immediate postoperative period

Apply KDIGO AKI definitions to AKI diagnosis

If TURP syndrome is diagnosed, initiate medical treatment:

Assess serum osmolality

Maintain asymptomatic and mildly symptomatic patients under close observation

Initiate hypertonic saline 3% infusion in symptomatic patients with marked hyponatremia, reduced osmolality and cerebral edema

Restrict diuretic use to treat fluid overload

If AKI occurs, test for hemolysis and rhabdomyolysis

Consider hemodialysis in symptomatic patients with severe renal disease

Patients that developed AKI should be followed and eGFR equations must be used to identify CKD

AKI: Acute kidney injury; CKD: Chronic kidney disease; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; D.W.: Distilled water; GFR: Glomerular filtration rate; KDIGO: Kidney disease improving global outcomes; TURP: Transurethral resection of prostate.