Roles of an Anesthesiologist during TURP

Transurethral resection of the prostate (TURP) is a common surgical procedure performed to alleviate symptoms of benign prostatic hyperplasia. As with any surgery, the anesthesiologist plays a critical role in ensuring patient safety, comfort, and optimal surgical conditions during TURP. From preoperative evaluation to intraoperative monitoring and postoperative care, the anesthesiologist’s responsibilities are multifaceted and pivotal to the procedure’s success.

Before the surgery, the anesthesiologist conducts a thorough preoperative assessment to evaluate the patient’s medical history, current health status, and potential risks associated with anesthesia. This includes reviewing cardiovascular, respiratory, and renal function, as many TURP patients are older and may have comorbid conditions such as hypertension, diabetes, or cardiac disease.

The anesthesiologist also assesses the patient’s coagulation status, as bleeding is a potential complication during TURP. Medications that may affect coagulation, such as anticoagulants, are carefully managed. Preoperative discussions with the patient help identify the most suitable anesthesia technique, whether spinal, general, or a combination. Spinal anesthesia is often preferred for TURP due to its benefits in providing excellent analgesia, facilitating early detection of any complications, and reducing postoperative recovery time. ^1,2. However, if general anesthesia is required, the anesthesiologist manages airway protection, ventilation, and depth of anesthesia throughout the procedure.

During the procedure, the anesthesiologist ensures the patient’s comfort, stability, and safety while supporting the surgical team. This involves administering and maintaining the chosen anesthesia technique and closely monitoring vital signs such as heart rate, blood pressure, oxygen saturation, and temperature. For patients under spinal anesthesia, the anesthesiologist ensures the block is effective and adjusts sedation levels as needed—pain management is tailored to the individual, minimizing discomfort while avoiding over-sedation ¹.

In addition to managing anesthesia, the anesthesiologist monitors fluid and electrolyte balance, which is critical during TURP. The procedure involves the use of an irrigation solution to maintain a clear surgical field, but excessive absorption of this fluid can lead to a condition known as TURP syndrome. This potentially life-threatening complication is characterized by hyponatremia, fluid overload, and neurological symptoms. Early recognition and management of TURP syndrome are essential, and the anesthesiologist plays a critical role in swiftly identifying and addressing issues ^1,3,4.

Other complications can include bleeding, cardiovascular instability, or allergic reactions. Continuous hemodynamic monitoring allows for the early detection of hypotension or arrhythmias, enabling immediate intervention to stabilize the patient.

Following the surgical procedure, the anesthesiologist ensures the patient’s smooth transition to recovery by managing postoperative pain, monitoring for complications, and supporting early mobilization. In cases of spinal anesthesia, the anesthesiologist assesses the resolution of the block and ensures that there are no lingering neurological effects—for patients under general anesthesia, careful monitoring continues until they regain full consciousness and stable vital signs. ^5,6.

An anesthesiologist’s expertise is integral to the success of TURP. From preoperative preparation to intraoperative management and postoperative care, they ensure patient safety, comfort, and optimal surgical conditions.

References

1. Leslie, S. W., Chargui, S. & Stormont, G. Transurethral Resection of the Prostate. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2024).
2. Hakenberg, O. W., Pinnock, C. B. & Marshall, V. R. Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcome. BJU Int 91, 375–379 (2003). DOI: 10.1046/j.1464-410x.2003.04078.x
3. Gupta, R. Anaesthesia For Transurethral Resection Of The Prostate (TURP). WFSA Resource Library https://resources.wfsahq.org/atotw/anaesthesia-for-transurethral-resection-of-the-prostate-turp/. (2009)
4. O’Donnell, A. M. & Foo, I. T. H. Anaesthesia for transurethral resection of the prostate. Continuing Education in Anaesthesia Critical Care & Pain 9, 92–96 (2009). DOI: 10.1093/bjaceaccp/mkp012
5. TURP Post-Operative Care | QProstate. Queensland Prostate Clinic https://qprostate.com.au/benign-prostate-hyperplasia/surgical-management/transurethral-resection-prostate-turp/post-operative-care/.
6. Transurethral resection of the prostate (TURP) – Recovery. nhs.uk https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/recovery/ (2018).