Transient Blindness Associated With Transurethral Resection of the Prostate

Creel, Donnell J.; Wang, Janice Mei-li; Wong, K. C.

doi:10.1001/archopht.1987.01060110083037

Cited by 20 publications

(8 citation statements)

References 14 publications

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“…Glycine but not arginine infusion in anesthetized dogs resulting in serum glycine levels in excess of 10,000 u.mol/L was associated with extinction of the visual evoked potential recorded from occipital cortex (4). In humans, electroretinogram (ERG) changes were consistently observed in patients experiencing visual Impairment (5). Patients whose visual acuity decreased to light perception often had unresponsive pupils.…”

Section: Introductionsupporting

confidence: 38%

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Glycine Inhibition of Pupillary Responses to Pulses of Light in Conscious Sheep

Seggie

Wright²

1989

Journal of Ocular Pharmacology and Therapeutics

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The use of a 1.5% glycine solution as a bladder irrigant during surgical removal of the prostate has been associated with transient visual impairment. Glycine is thought to be an inhibitory retinal transmitter. Adult female sheep were infused with a 1.5% glycine solution to provide a dose of 0, 7.5, 15, 30, or 60 g of glycine. The volume control was a solution of dextrose and saline. The degree of constriction of the pupil in response to 30 seconds of bright light following dilation in the dark was used as an index of visual response. Observations were made before and 2, 4, 6, 12, 24, 48, 96, and 192 hours after a single infusion. Significant inhibition of pupil response to light but not to the dark was apparent following systemically administered glycine resulting in plasma levels over 5000 u.mol/L. Inhibition of pupil response was paralleled by behavioral indices of visual impairment but not by changes in plasma sodium, potassium, chloride or osmolality. The duration of the effect was dose dependent with visual impairment following a single high dose of glycine being detectable five days later and long after glycine levels had returned to normal. However, the relationship between dose, time, and effect appears to be complex. It is important to note that the present observations occurred at plasma glycine levels frequently experienced in routine surgical practice. The finding that significant long term detrimental effects of glycine could be detected should evoke a re-evaluation of the use of glycine as an irrigating solution for surgical procedures and stimulate further investigation of the effects of glycine on retinal function and the ability to perceive light.

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Section: Introductionsupporting

confidence: 38%

“…These effects could not be attributed to changes in serum sodium ¡on levels but rather to serum glycine levels. Indeed Creel (5) concluded that ERG changes were found when serum glycine levels exceed 2500 umol/L (19 mg/dL) and visual impairment was reported when serum glycine exceeded 4000 umol/L.…”

Section: Introductionmentioning

confidence: 38%

Glycine Inhibition of Pupillary Responses to Pulses of Light in Conscious Sheep

Seggie

Wright²

1989

Journal of Ocular Pharmacology and Therapeutics

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“…The visual symptoms range from ''dim vision'' to temporary blindness lasting for several hours. 24,25…”

Section: Presentationmentioning

confidence: 99%

Transurethral Resection of the Prostate Syndrome: Almost Gone but Not Forgotten

Hawary

Mukhtar

Sinclair

et al. 2009

Journal of Endourology

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Transurethral resection of the prostate (TURP) syndrome is a rare but potentially fatal syndrome with multifactorial pathophysiology that is now better understood. Unfortunately, despite this improved understanding, it is not yet obsolete and still remains a risk. Many reviews of TURP syndrome have been presented from an anesthetic perspective; this review reflects more the urologic perspective with emphasis on the importance of multidisciplinary management of this complex syndrome. We present a review of TURP syndrome that specifically assesses advances in the understanding of risk factors, pathophysiology, and techniques used to prevent this syndrome. The databases Medline, Embase, Cochrane Controlled Trial Register, and Database of Abstracts of Reviews of Effects were systematically reviewed from inception to April 2009 for the keywords TUR (P), TUR (P) syndrome, and transurethral resection of prostate. There was no language restriction for our search. Randomized controlled trials, review articles and case series were included in our search. Our review showed a declining trend in the incidence of TURP syndrome despite TURP remaining the gold standard for the management of benign prostatic obstruction. Technologic advances using an array of laser techniques, the use of bipolar circuitry, together with advances in training techniques have helped minimize the risk of development of this syndrome. This review demonstrates the complexity of TURP syndrome. Even with a greater understanding of the pathophysiology, it highlights the unpredictability of the syndrome from presenting symptoms, preventative measures, and management. TURP syndrome cannot be protocol driven and the need for vigilance, a high index of suspicion, intensive monitoring, and a multidisciplinary approach is vital.

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“…Glycine (0.16-0.24 M), a component of Gamunex 10% that is used as a stabilizing agent, has been associated with suppression of the electroretinogram and reduced visualevoked potentials in visually symptomatic patients receiving glycine-containing infusion fluids during transurethral resection of the prostate. [13][14][15][16] In an experimental mouse model, intravenous infusion of glycine 1.5% (0.2 M) was associated with cardiac death due to electrophysiologic disturbances. 17 Glycine toxicity may thus be of relevance when considering various preparations of human IgG for intraocular therapy.…”

Section: Discussionmentioning

confidence: 99%