Glycine Solution as an Irrigating Agent During Transurethral Prostatic Resection: Glycine Concentrations in Blood Plasma

Abstract

In 17 men undergoing transurethral resection of the prostate (TURP), an isosmotic solution of 2.2% glycine was used for irrigation. The plasma glycine concentration was determined before and immediately after TURP and 2, 6, 24 and 48 hours later. The serum concentrations of sodium, albumin and prostatic acid phosphatase protein (PAP) were used as indicators of fluid absorption. Calculation of the absorbed fluid volume was based on the plasma concentration of glycine, and the disappearance rate of glycine from plasma was estimated. The mean disappearance rate (T 1/2) was 85 min, which was midway between previously observed rates for sorbitol and mannitol. The observed plasma glycine increase after TURP correlated well with fall in serum sodium and rise in serum PAP, with the blood loss during and up to 15 min after TURP, and also with the weight of the resected tissue. The plasma glycine level, highest immediately after TURP, normalized 24-48 hours postoperatively. No signs of ammonia intoxication or marked serum urea increase were seen in these patients, although some had very high plasma glycine values after TURP (mean 10.2, maximum 23 mmol/l) as compared with the preoperative levels (mean 0.2 mmol/l). There was some increase of plasma serine (a normal metabolite of glycine) after TURP. The authors conclude that the irrigating fluid should have a minimal concentration of glycine, near to the level of haemolysis onset, to minimize the plasma dilution effects, including hyponatraemia, and the appearance of metabolites when the irrigating fluid is absorbed.

Plasma Haemoglobin Concentrations and Other Influx Variables in Blood in Connection with Transurethral Resection of the Prostate Using Distilled Water as an Irrigating Fluid

“…After absorption of the irrigating Table V fluid the volume of distribution is large, for, in principle, it corresponds to the total body water, i.e., approximately 55% of body weight (29). Iso-osmolar irrigating fluids (20,23,24) produce effects corresponding to plasma volume expansion with a decrease in S-Na and serum protein concentrations immediately postoperatively (8,9,27). A marked decrease in S-Na may contribute to the symptomatology of the TURP syndrome (19).…”

“…Thus no signs of haemodilution were seen, whereas haemodilution effects are obtained when iso-tonic solutions are used as irrigating fluids (22,23,24).…”

“…This may be interpreted as a release of iron in connection with the breakdown of haemoglobin and the haptoglobinhaemoglobin complex. In the case in which glycine solution was used as an irrigation fluid (24) and determinations of serum iron were performed up to 48 hours postoperatively, a maximum was obtained after 6 hours (Table IV). In cases where iso-tonic ir-rigating fluids were used there was only slight haemolysis (21) (Fig.…”

A Comparison Between two Hypotonic Irrigating Solutions used in Transurethral Resections of the Prostate: Sorbitol (2%)-Mannitol (1%) and 1.5% Glycine Solutions

“…Plasma glycine was analysed by ion exchange chromatography after precipitation of proteins with sulphosalicylic acid (8,11) using an LKB Alfa-plus amino acid analyser. Other methods used have been described previously (7).…”

Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy

“…Many methods of measuring irrigant absorption have been investigated [6][7][8][9][10][11][12][13][14][15][16][17][18][19] but most have proved impractical or inaccurate. Two are more promising, i.e.…”