A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection

Abstract

An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects.

Effect of glycine on the calcium signal of thrombin-stimulated platelets

“…The dilutional hyponatremia and the toxicity of glycine metabolites explain the clinical symptoms [8]. Glycine levels between 16 and 36 mmol/l were found in patients with transurethral resection reaction syndrome [9], so the concentrations used in this study could not be used in vivo. The side effects exclude the possibility of hyperosmotic glycine as an alternative to hyperosmotic saline for resuscitation.…”

Renal dysfunction and fluid and electrolyte disturbances

“…Excessive absorption of fluid can cause intravascular overload and/or electrolyte disturbances to the point that symptoms are produced [46]. The ideal irrigant for endoscopic resection would be a nonconductive solution that does not interfere with electrosurgical resection, has a high degree of translucency, has an osmolarity similar to the serum and causes only minimal side-effects when absorbed [47]. A prospective controlled trial was done on 360 patients undergoing transurethral resection of the prostate using three types of irrigating fluids (1.5%, glycine, 5% glucose and normal saline).…”

Transurethral resection of prostate: technical progress and clinical experience using the bipolar Gyrus plasmakinetic tissue management system

“…When using glycine, this absorption can also include hyperammonemia and lead to cerebral edema and seizures [5].…”

“…The fluid flow must be sufficient to clear the surgical site of bleeding, so the pressure of the fluid must be greater than or equal to the pressure of the blood coming from the tissue. The open capillaries in the cut tissue provide access for the irrigating fluid to enter the bloodstream, which results in a hypervolemic state with dilutional hyponatremia [3,4].When using glycine, this absorption can also include hyperammonemia and lead to cerebral edema and seizures [5].TURP can be associated with significant morbidity, including intra-and postoperative bleeding with need for blood transfusions, incontinence, stricture formation, and rare complications such as bladder perforation and diathermy burns from poorly applied return electrodes used to complete the circuit; malfunction of certain types of pacemakers has been reported during the use of monopolar diathermy [6].However, recent developments in TURP have significantly decreased the associated morbidity.The relatively high incidence of complications traditionally associated with TURP has driven the development …”