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After a 75-minute procedure, he developed hypertension, pallor, shivering, and multiple laboratory abnormalities including hyponatremia, anemia, thrombocytopenia, leukocytosis, and acute liver and kidney injury. Early recognition and electrolyte- and organ-directed management led to rapid clinical improvement. Uniquely, mild anemia and elevated creatinine persisted for years, supported by this case and literature 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\nContents lists available at ScienceDirect Urology Case Reports  \njournal [homepage:](homepage: www.elsevier.com/locate/eucr)[ www.elsevier.com/locate/eucr](homepage: www.elsevier.com/locate/eucr)  \n| Endourology\u003Cbr>Multiorgan involvement and residual effects in transurethral resection of prostate syndrome: A case report and literature review |  |  | |\n| --- | --- | --- | --- |\n| Paulus Chandra a, Santoso Chandra b, Sawkar Vijay Pramod c,d,* \u003Cbr>a Undergraduate Medical Study Program, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia b Department of Internal Medicine, Immanuel Hospital Bandung, Bandung, West Java, 40233, Indonesia\u003Cbr>c Department of Urology, Hasan Sadikin Academic Medical Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia d Department of Surgery, Urology Division, Immanuel Hospital Bandung, Bandung, West Java, 40233, Indonesia |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Keywords:\u003Cbr>Case report\u003Cbr>Chronic kidney disease\u003Cbr>Hyponatremia\u003Cbr>Transurethral resection of prostate |  | A 71-year-old man with bothersome lower urinary tract symptoms from an enlarged prostate underwent monopolar transurethral resection of the prostate (TURP). Following the 75-min procedure, he developed hypertension, pallor, and shivering. Laboratory tests demonstrated hyponatremia, anemia, thrombocytopenia, leukocytosis, and acute liver and kidney injury. Prompt recognition and management of electrolyte and organ involvement led to rapid improvement. However, unique to this case, mild anemia and elevated creatinine remained for years. This case and review emphasize the need to anticipate multiorgan involvement, including hepatic and renal impairment, as well as potential residual effects, in patients with TURP syndrome. |  |\n\n1. Introduction  \nTransurethral Resection of Prostate (TURP) uses endoscopic techniques to remove prostate tissue,1 which has remained the gold standard surgical treatment for lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement.2 However, the procedure carries serious risks, including TURP syndrome. TURP syndrome is dilutional hyponatremia from absorption of large amounts of hypotonic irrigation fluids. Despite having a low incidence rate of just 2 %,3 TURP syndrome poses a serious risk to the patient’s well-being.  \nIn many resource-limited settings, monopolar TURP remains the primary surgical option for benign prostatic obstruction, and sterile distilled water continues to be used for irrigation because of its availability and low cost,4 a practice also seen in our local institution. Studies from similar settings have also reported safety and functional outcomes comparable to those of glycine-based solutions when strict intraoperative monitoring is applied.5,6 This context explains its use in the present case, where access to glycine-based irrigants was limited.  \nSigns of TURP syndrome might start to occur both intraoperatively and postoperatively; therefore, early detection and prompt management are crucial to minimize adverse impacts on the patient’s overall prognosis. The case presented in this report is an example of the latter, in which the patient shows signs just after the procedure is finished. In  \naddressing TURP syndrome, it is important not to focus solely on its electrolyte imbalance, but also anticipate possible multiple organ involvement. Previous studies have shown that TURP syndrome has systemic implications and may seriously affect multiple key organs.7 Additionally, with years-long follow up, this present case illustrates TURP syndrome with long-term residual hematologic parameters and renal function impairments, phenomenons that have not been previously reported. Therefore, this report aimed to reiterate the importance of continuous surveillance of the patient’s condition to anticipate TURP syndrome, its multiorgan involvement, and possible novel ","cbCaii5YygOU59TD","https://ap.wps.com/l/cbCaii5YygOU59TD","pdf",651645,"English","# Introduction\n# Case presentation","[{\"question\":\"What surgery and irrigation method were used in the case?\",\"answer\":\"The patient underwent monopolar transurethral resection of the prostate (TURP) with continuous irrigation using sterile water.\"},{\"question\":\"What complications developed after the TURP procedure?\",\"answer\":\"Immediately after surgery, the patient developed hypertension, pallor, and shivering, with laboratory evidence of hyponatremia plus anemia, thrombocytopenia, leukocytosis, and acute liver and kidney injury.\"},{\"question\":\"What residual effects were reported long after the acute event?\",\"answer\":\"Mild anemia and elevated creatinine remained for years despite rapid improvement after prompt management.\"}]","Multiorgan involvement and residual effects in transurethral resection of prostate syndrome - A case report and literature review | PDF",1790731860]