Transurethral Resection of Prostate: A Continuing Battle of Irrigating Fluids

Abstract

Background: Transurethral resection (TUR) syndrome is a complication arising from the excessive absorption of irrigating fluid during endoscopic transurethral resection of the prostate (TURP), leading to central nervous system changes, and circulatory and electrolyte imbalances. This study compares the effects of using glycine 1.5%, glucose 5%, and normal saline 0.9% as irrigating solutions in TURP.

Objective: To determine the efficacy and safety of glycine 1.5%, glucose 5%, and normal saline 0.9% as irrigating solutions in reducing perioperative morbidity and TUR syndrome incidence in patients undergoing TURP.

Methods: In this prospective, randomized controlled trial, 360 patients with moderate to severe bladder outlet obstruction from benign prostatic hyperplasia were divided into three groups: glycine (120), glucose (120), and saline (120), using respective irrigating solutions. Parameters such as operation time, hospital stay, and perioperative complications were recorded.

Results: The glycine group exhibited a higher incidence of TUR syndrome, with three cases noted. No cases were observed in the saline group, while two occurred in the glucose group. Postoperative hyperglycemia was recorded in the glucose group (170 ± 35.9 mg/dl), along with hypokalemia (3.67 ± 0.92 mmol/l). A slight increase in serum sodium (142.6 ± 12.6 mmol/l) was observed in the saline group.

Conclusion: TURP using glucose 5% or saline 0.9% as irrigating solutions is associated with lower perioperative morbidity, reduced catheterization duration, shorter hospital stays, and an absence of cardiac toxicity compared to the use of glycine 1.5%.