Title: A Comparative Study of ‘Sterile Water’ Versus ‘Glycine (1.5%)’ As Irrigation Fluid in Transurethral Resection of Prostate
Authors: Dr Kshitija Kulshreshtha, Dr Ranjeeta Tambey, Dr Naresh G. Tirpude
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.40
Abstract
Aims and Objectives: The present research study was carried out with an objective to study and compare the effects of Sterile Water versus Glycine (1.5%) as an irrigation fluid in surgery of ‘Trans-Urethral Resection of Prostate (TURP).
Methods: This was a prospective randomized double blind study. A total of 60 patients of (Age: 50-80 years) ASA grade I and II with Benign Prostatic Hyperplasia posted for trans-urethral resection of prostate were randomly allocated in two equal groups as Group W- Sterile Water group and Group G- Glycine1.5% group. The observations in relation to intra-operative haemo-dynamics, haemoglobin, blood urea, serum creatinine and serum electrolyte changes were noted and analyzed.
Results: Statistically there were similar changes in heart rate, systolic and diastolic blood pressures during the procedure in both the groups. Immediately after surgery and after 24 hrs, the comparable changes were seen in both the groups in relation to haemoglobin, blood urea and serum creatinine levels. Post-operative serum sodium concentration was decreased and serum potassium concentration was increased significantly in both groups. These changes in serum sodium & potassium were more so in Group W as compared to in Group G; but the difference in two groups was statistically insignificant. Incidence of perioperative complications was comparable amongst the groups.
Conclusion: As compared to Glycine (1.5%), Sterile Water was found to be safe and inexpensive irrigation fluid for ‘Trans-Urethral Resection of Prostate’ (TURP). In relation to safety profile, we did not find any difference between two irrigation fluids. As our sample size of study was small, needs further similar studies on large sample size to confirm the observations of present study.
Keywords: Irrigation fluids: Sterile water Vs. Glycine, Trans-Urethral Resection of Prostate (TURP), Benign Prostatic Hyperplasia, TURP syndrome.
References
1. Moorthy H K, Philip S. TURP syndrome - current concepts in the patho-physiology and management. Indian J Urol 2001; 17:97-102.
2. Porter M, McCormick B. Anaesthesia for transurethral resection of prostate. WFSA Update in Anaesthesia 2003; 25(16): 21-6
3. Hahn RG: Fluid absorption in endoscopic surgery. Br J Anesthesia. 2006, 96: 8-20.
4. Hahn RG: Hallucination and visual disturbances in transurethral prostatic resection. Intensive Care Med. 1988, 14: 668-71.
5. Byard RW, Harrison R, Wells R, Gilbert JD. Glycine toxicity and unexpected intra-operative death. J Forensic Sci2001; 46: 1244–6.
6. Coppinger SW, Lewis CA, Milroy EJ. A method of measuring fluid balance during transurethral resection of the prostate. Br J Urol. 1995; 76:66–72.
7. Permi J: Serum acid phosphatase in TUR syndrome. Ann. Chir. Gynecol. Suppl. 1993; 206: 24-30.
8. Hahn RG. Acid phosphatase levels in serum during transurethral prostatectomy. Br J Urol. 1989; 64:500–3.
9. Hultén JO, Tran VT, Pettersson G. The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method. BJU Int. 2000; 86: 989–92.
10. Hahn RG, Olssen J: Ethanol monitoring of the transurethral resection syndrome. J Clin Anesth. 1996, 8: 652-5.
11. Bender DA, Coppinger SW. Estimation of irrigant absorption during transurethral resection of the prostate-assessment of fluorescein as a marker. Urol Res. 1992; 20:67–9.
12. Hahn RG. Smoking increases the risk of large-scale fluid absorption during transurethral prostatic resection. J Urol. 2001; 166:162–5.
13. Agarwal R, Emmett M. The post transurethral resection of prostate syndrome- therapeutic proposals. Am J Kidney Dis. 1994; 24:108–11.
14. Hahn RG: Irrigating fluids in endoscopic surgery. Br J Urol. 1997, 79: 669-80.
15. Moorthy K, Philip S. Serum electrolytes in TURP syndrome- Is the role of potassium under-estimated? Indian J. Anaesth. 2002; 46(6): 441-4.
16. Moharari RS, Khajavi MR, Khademhosseini P, Hosseini SR, Najafi A. Sterile water as an irrigating fluid for transurethral resection of the prostate: anesthetical view of the records of 1600 cases. South 2008 Apr; 101(4):373-5.
17. Memon A, Buchholz N-P, Salahuddin S. Water as an irrigant in transurethral resection of the prostate: a cost-effective alternative. Arch Ital Urol Androl 1999; LXXI: 131–4.
18. Aghamir SM, Alizadeh F, Meysamie A, Assefi Rad S, Edrisi L. Sterile water versus isotonic saline solution as irrigation fluid in percutaneous nephro-lithotomy. Urol J. 2009; 6:249-53.
19. Dissayabutraa T. Irrigation with water during transurethral resection of the prostate (TURP) induces intravascular hemolysis. Asian Biomed. 2014 Feb 21; 7(6):795.
20. Shih HC, Kang HM, Yang CR, Ho WM. Safety of distilled water as an irrigating fluid for transurethral resection of the prostate. J Chin Med 1999 Aug; 62(8):503-8.
21. Norlen H, Allegen LG: A comparison between intermittent and continuous transurethral resection of the prostate. Scand. J. Urol. Nephrol. 1993; 27(1): 21-5.
22. Moskovitz B, Ross M, Bolkier M, Rosenberg B, Levin DR: The use of distilled water as an irrigating fluid in patients undergoing transurethral resection of the prostate. Eur. Urol. 1989; 16(4): 267-70.