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

Abstract

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

1H NMR-based Plasma Metabolic Profiling of Dairy Cows with Type I and Type II Ketosis

“…The δ5.5-9.0 region (dashed box) was magnified 10 times relative to the δ0.5-5.5 region for clarity. The samples K 1-15 , K 1-16 , K 2-8 , K [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] , and C 8 were removed to achieve a better quality of spectrum and a better suppression effect of the water peak. The data were subsequently analyzed using multivariate statistics (PCA and OPLS-DA).…”

“…In general, ketosis is closely related to negative energy balance (NEB), poor appetite, and high milk production during early lactation, which may contribute to inadequate energy intakes [2]. There are two types of ketosis: clinical ketosis and subclinical ketosis, based on the clinical symptoms, e.g., anorexia, depression, decreased milk production, constipation, drowsiness or nervousness [3], and plasma 3-hydroxybutyrate acid levels (BHBA, >1.20 mmol/L) [4]. However, Holtenius et al [5] reported that ketosis in dairy cattle is divided into types I and II based on the disease characteristics and clinical features.…”

Glycine 1.5% for Irrigation Should Be Abandoned

“…In another study, troponin levels also rose equally in patients who received glycine or glucose, but only serum glycine correlated with ischaemic changes on the ECG [32]. Yousef et al [33] reported that 6 out of 120 patients developed ischaemic changes on the ECG and that 3 showed elevated serum troponin levels after the surgery; this occurred only with glycine irrigation.…”

“…Yousef et al [33] compared symptoms in 360 patients following irrigation with glycine 1.5%, glucose 5% and isotonic saline. The resection weights were unusually large (average 90 g).…”

“…Studies of bipolar TURP usually overcome this lack by reporting the number of ‘TUR syndromes', which is defined as a combination of poorly specified symptoms that co-exist with hyponatraemia (serum sodium <130 mmol/l) [33,60] or else as hyponatraemia alone [61,62,63]. Problems with this approach include the fact that symptoms may be caused by factors other than fluid absorption (such as haemorrhage) and that saline does not decrease serum sodium [28,44].…”