The prostate sits just below the bladder and wraps around the urethra. As men age it often grows (BPH) and squeezes the urethra, making it hard to empty the bladder.
TURP: a resectoscope goes through the urethra. No cuts are needed. A wire loop carrying electric current shaves the prostate from the inside, a strip at a time, to open the channel. The same current seals bleeding vessels.
Chips: the shaved pieces collect in the bladder. They are washed out at the end and sent to pathology.
Afterward: a 3-way catheter is placed with continuous bladder irrigation (CBI) to wash out blood and keep clots from forming.
Why glycine, not saline: monopolar current spreads out in saline and will not cut, so the resection needs a fluid that does not conduct electricity (glycine or water). Saline is used only after the resection, for CBI.
What is TUR syndrome? During the resection, small veins in the prostate are opened and soak up irrigation fluid. Glycine and water contain no salt, so absorbing a lot of either waters down the salt (sodium) in the blood. Low sodium can cause confusion, nausea and vomiting, a slow heart rate, low blood pressure and, in severe cases, seizures. Water is the riskier of the two: the longer it runs, the more is absorbed, and it can also burst red blood cells.
Why no pressure: pressure pushes more fluid into those open veins. Keeping the bags low, by gravity only, limits how much is absorbed.
Tell the surgeon if a bag runs out or the irrigation stops flowing.