Glycine 1.5% for Irrigation Should Be Abandoned

Abstract

Background: Glycine 1.5% has long maintained a dominating role as an irrigating solution for monopolar transurethral resection of the prostate (TURP), as well as for certain other transurethral procedures. Materials and Methods: This review summarizes the findings ofsystematic experimental and clinical studiesin which glycine 1.5% for irrigation was infused/absorbed and the outcome compared to at least one other irrigating fluid, including the isotonic saline used for bipolar TURP. Results: There were 11 studies in animals, 3 in volunteers and 6 in patients undergoing TURP. With only one exception, which is probably due to low power, these studies either show a poorer outcome after administration or absorption of glycine solution or else that glycine 2.2% is more toxic than glycine 1.5%. The poorer outcomes consisted of more tissue damage or higher mortality (animals) or more symptoms (volunteers and patients). Conclusion: The safety of monopolar TURP would be improved by replacing glycine 1.5% with some other electrolyte-free fluid. The author argues that glycine 1.5% should be abandoned completely.

Absorption of irrigation fluid during XPS™ GreenLight laser vaporization of the prostate: results from a prospective breath ethanol monitoring study

“…This threshold volume has previously been identified to be of clinical relevance for isotonic saline influx [17]. Volume and chloride overload can lead to pulmonary edema, hyperventilation, hyperchloremic acidosis, reduced glomerular filtration rate (up to 15%), suppression of the renin-angiotensin system (up to 60%), hypotension, impaired myocardial function and abdominal pain [16][17][18][26][27][28]. The symptoms we observed were transient, only mild to moderate and did not require extensive treatment.…”

“…Furthermore, predefined intra-and postoperative symptoms, potentially related to excess fluid absorption (i.e. neurologic or cardiovascular) were recorded [16][17][18].…”

Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature

“…ere was a statistically significant less mean fluid deficit in the study group than the control group in endometrial polypectomy and myomectomy patients but not in those who underwent septal resection [21]. e 1.5% glycine is one of the most common solutions used in monopolar hysteroscopic procedures due to its nonhemolytic, nonconductive, and transparent properties, although it is more toxic and has poorer outcomes when confronted with other options [22]. e absorption of glycine solution into the extracellular space will make the blood hypertonic with a higher volume, which will draw the fluid outside the cells.…”

“…The 1.5% glycine is one of the most common solutions used in monopolar hysteroscopic procedures due to its nonhemolytic, nonconductive, and transparent properties, although it is more toxic and has poorer outcomes when confronted with other options [ 22 ]. The absorption of glycine solution into the extracellular space will make the blood hypertonic with a higher volume, which will draw the fluid outside the cells.…”

Fluid absorption and the ethanol monitoring method

“…With monopolar electrocautery, the irrigating solution needs to be electrolyte‐free but contain glycine, mannitol, or sorbitol to avoid hemolysis in case absorption occurs. Glycine‐containing solutions have been associated with the most serious adverse effects in clinical patients and when administered to volunteers and experimental animals …”