Symptoms of the Transurethral Resection Syndrome Using Glycine as the Irrigant

Olsson, Joel; Nilsson, Anders; Hahn, Robert G.

doi:10.1016/s0022-5347(01)67246-x

Cited by 98 publications

(50 citation statements)

References 20 publications

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“…3,4 Nevertheless, significant complications remain associated with TURP and the general morbidity rate of TURP is 18% and the overall mortality rate ranges between 0.17% and 0.77%. 3,[5][6][7][8][9][10] Due to significant complication rates observed following TURP, several studies have evaluated the safety and efficacy of new surgical techniques to potentially minimize the risks of TURP to treat lower urinary tract symptoms (LUTS) resulting from BPH. [1][2][3][4] Recent trials investigating for the optimal surgical treatment for BPH compare different modalities in terms of minimal invasiveness, postoperative complications, physiological changes and outcomes.…”

Section: Introductionmentioning

confidence: 99%

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP: Early complications, physiological changes and postoperative follow-up outcomes

Aydoğdu

Karakose

Atesci

2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(7-8):e485-9. http://dx.doi.org/10.5489/cuaj.1772 Published online July 18, 2014. Abstract Introduction:We compare BIVAP saline vaporization of the prostate with bipolar transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. Methods: In total, we included 86 patients treated with BIVAP (n = 44) and bipolar TURP (n = 42). The inclusion criteria were maximum urinary flow rate (Qmax) ≤10 mL/s, International Prostate Symptom Score (IPSS) ≥16, and prostate volume measured with transrectal ultrasound scan between 30 and 80 mL. Serum electrolyte, hemoglobin, and hematocrit levels were determined preoperatively and postoperatively. All patients were evaluated at the postoperative first and third months and the IPSS score, post-void residual urinary volume (PVR), Qmax, and average urinary flow rate (Qave) were compared. Statistical analyses were performed using SPSS 16.0 program and statistical significance was set at p < 0.05. Results: Preoperative demographic characteristics were similar in the 2 groups. The mean operation time was significantly higher (p = 0.02) and hospitalization time was significantly lower (p = 0.04) in the BIVAP group when compared to the bipolar TURP group. There was no significant difference between 2 groups in terms of preoperative and postoperative serum electrolyte, hemoglobin and hematocrit levels. Postoperative complication rates were similar in the 2 groups. The only exception was the rate of severe dysuria, which was significantly higher in the BIVAP group. No statistical difference was noted between the groups in terms of postoperative follow-up results. Conclusion: Bipolar TURP is a safe and highly effective technique which can be used in the surgical treatment of benign prostatic obstruction with minimal side effects. BIVAP saline vaporization of the prostate seems to be a potential alternative to bipolar TURP with shorter hospitalization time.

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Section: Introductionmentioning

confidence: 99%

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP: Early complications, physiological changes and postoperative follow-up outcomes

Aydoğdu

Karakose

Atesci

2014

CUAJ

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“…Severe forms of TUR syndrome are more rare but they require treatment in the intensive care unite (ICU) at least over night. The incidence and severity of symptoms of TUR syndrome increase progressively as more glycine solution is absorbed during TURP and the severity of symptoms is markedly aggravated when more than 3,000 ml are absorbed [4]. Deaths have been reported in patients undergoing TURP.…”

Section: Introductionmentioning

confidence: 99%

A randomized comparison between three types of irrigating fluids during transurethral resection in benign prostatic hyperplasia

Yousef¹,

Suliman²,

Elashry³

et al. 2010

BMC Anesthesiol

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Background: Central nervous system changes, circulatory and electrolyte imbalances are the main complications of endoscopic transurethral resection of the prostate (TURP) which is known as transurethral resection (TUR) syndrome, which occurs as result of excessive absorption of irrigating fluid. We compare glycine 1.5% versus glucose 5% and normal saline 0.9% as irrigating solutions during TURP in patients with moderate to severe bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Methods:Three hundred sixty patients with symptomatic BPH were randomized into a prospective, controlled trial comparing the three irrigation modalities. One-hundred twenty patients used glycine 1.5% solution as irrigating fluid (glycine group), 120 patients used glucose 5% solution (glucose group) and 120 patients used normal saline 0.9% solution (saline group). Patient's demographics, operation time, hospital stay, postoperative amino acid glycine assay, postoperative serum cardiac troponin I and perioperative complications were noted. Results:No difference was found between the groups in the immediate postoperative levels of hemoglobin and hematocrite. A high glycine level was associated with the TUR syndrome. Seventeen patients had TUR syndrome; all were in glycine group and they had the highest postoperative amino acid glycine levels. Slight increase in serum sodium (142.6 ± 12.6 mmol/l) was detected in saline group. Transient Hyperglycemia (170 ± 35.9 mg/dl) and hypokalemia (3.67 ± 0.92 mmol/l) occurred in the immediate postoperative period in the glucose group. Conclusion:Endoscopic TURP performed using either glucose 5% or saline 0.9% irrigating solution during and after surgery is associated with lower incidence of TUR syndrome, lower catheterization period, shorter hospital stay and no cardiac toxicity in comparison with glycine 1.5% solution.Trial Registration: This clinical trail had been approved and registered in PACT Registry; with identification number for the registry is ATMR2010010001793131. BackgroundMany endoscopic surgical procedures require the use of an irrigating fluid to dilate the operating field and to wash away debris and blood. A potential complication of such irrigation is a systemic absorption of the fluid to the extent that overt symptoms are produced [1]. The ideal irrigant for endoscopic resection would be a userfriendly, non-conductor medium that does not interfere with diathermia, has a high degree of translucency, has similar osmolarity to the serum and causes only minimal

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“…In general, adverse symptoms (i.e., nausea, vomiting, confusion, and arterial hypotension) are more common if glycine solutions of 1000 to 2000 mL are absorbed. [21,22] Based on the result from a correlation analysis—between the irrigating fluid absorbed and the changes in ROTEM—there may be greater coagulation pathway impairment (hypocoagulability) with increased volume of irrigating fluid absorption.…”

Section: Discussionmentioning

confidence: 99%

The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate

Shin

Jeon

et al. 2017

Medicine

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Although endoscopic transurethral resection of the prostate (TURP) is a well-established procedure as a treatment for benign prostatic hyperplasia, its complications remain a concern. Among these, coagulopathy may be caused by the absorption of irrigating fluid. This study aimed to evaluate such phenomenon using a rotational thromboelastometry (ROTEM).A total of 20 patients undergoing TURP participated in this study. A mixture of 2.7% sorbitol–0.54% mannitol solution and 1% ethanol was used as an irrigating fluid, and fluid absorption was measured via the ethanol concentration in expired breath. The effects on coagulation were assessed by pre- and postoperative laboratory blood tests, including hemoglobin, hematocrit, platelet count, international normalized ratio of prothrombin time (PT-INR), activated partial thromboplastin time, electrolyte, and ROTEM.INTEM-clotting time (INTEM-CT) was significantly lengthened by 14% (P = 0.001). INTEM-α-angle was significantly decreased by 3% (P = 0.011). EXTEM-clot formation time was significantly prolonged by 18% (P = 0.008), and EXTEM-maximum clot firmness (EXTEM-MCF) was significantly decreased by 4% (P = 0.010). FIBTEM-MCF was also significantly decreased by 13% (P = 0.015). Moreover, hemoglobin (P < 0.001), hematocrit (P < 0.001), platelet counts (P < 0.001), potassium (P = 0.024), and ionized calcium (P = 0.004) were significantly decreased, while PT-INR (P = 0.001) was significantly increased after surgery. The amount of irrigating fluid absorbed was significantly associated with the weight of resected prostatic tissue (P = 0.001) and change of INTEM-CT (P < 0.001).As shown by the ROTEM analysis, the irrigating fluid absorbed during TURP impaired the blood coagulation cascade by creating a disruption in the coagulation factor activity or by lowering the coagulation factor concentration via dilution.

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Symptoms of the Transurethral Resection Syndrome Using Glycine as the Irrigant

Cited by 98 publications

References 20 publications

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP: Early complications, physiological changes and postoperative follow-up outcomes

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP: Early complications, physiological changes and postoperative follow-up outcomes

A randomized comparison between three types of irrigating fluids during transurethral resection in benign prostatic hyperplasia

The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate

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