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 of systematic experimental and clinical studies in 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.
References
1.
Nesbit RM, Glickman SI: The use of glycine solution as an irrigating medium during transurethral resection. J Urol 1948;59:1212-1216.
2.
Ovassapian A, Joshi CW, Brunner EA: Visual disturbances: an unusual symptom of the transurethral prostatic resection reaction. Anesthesiology 1982;57:332-334.
3.
Hoekstra PT, Kahnoski R, McCamish MA, Bergen W, Heetderks DR: Transurethral prostatic resection syndrome - a new perspective: encephalopathy with associated hyperammonemia. J Urol 1983;130:704-707.
4.
Harrison RH, Boren JS, Robison JR: Dilutional hyponatremic shock: another concept of the transurethral prostatic resection reaction. J Urol 1956;75:95-110.
5.
Handler P, Kamin H, Harris JS: The metabolism of parenterally administered amino acids. J Biol Chem 1949;179:283-301.
6.
Drinker HR, Shields T, Grayhack JT, Laughlin L: Simulated transurethral resection in the dog: early signs and optimal treatment. J Urol 1963;89:595-602.
7.
Boxenbaum H: Interspecies scaling, allometry, physiological time and the ground plan for pharmacokinetics. J Pharmacokinet Biopharm 1982;10:201-227.
8.
Zhang W, Hahn RG: ‘Double toxicity' of glycine solution in the mouse. Br J Urol 1996;77:203-206.
9.
Olsson J, Hahn RG: Survival after high-dose intravenous infusion of irrigating fluids in the mouse. Urology 1996;47:689-692.
10.
Olsson J, Hahn RG: Glycine toxicity after high-dose intravenous infusion of glycine 1.5% in the mouse. Br J Anaesth 1999;82:250-254.
11.
Olsson J, Sandfeldt L, Hahn RG: Survival after high-dose intraperitoneal infusion of glycine solution in the mouse. Scand J Urol Nephrol 1997;31:119-121.
12.
Hahn RG, Nennesmo I, Rajs J, Sundelin B, Wroblevski R, Zhang W: Morphological and X-ray microanalytical changes in mammalian tissue after overhydration with irrigating fluids. Eur Urol 1996;29:355-361.
13.
Maatman TJ, Musselman P, Kwak YS, Resnick MI: Effect of glycine on retroperitoneal and intraperitoneal organs in the rat model. Prostate 1991;19:323-328.
14.
Zhang W, Andersson B, Hahn RG: Effect of irrigating fluids and prostatic tissue extracts on isolated cardiomyocytes. Urology 1995;46:821-824.
15.
Hahn RG, Zhang W, Rajs J: Pathology of the heart after overhydration with glycine solution in the mouse. APMIS 1996;104:915-920.
16.
Hahn RG, Olsson J, Sótonyi P, Rajs J: Rupture of the myocardial histoskeleton and its relation to sudden death after overhydration with glycine 1.5% in the mouse. APMIS 2000;108:487-495.
17.
Sandfeldt L, Riddez L, Rajs J, Ewaldsson CA, Piros D, Hahn RG: High-dose intravenous infusion of urological irrigating fluids containing glycine and mannitol in the pig. J Surg Res 2001;95:114-125.
18.
Hahn RG, Stalberg HP, Gustafsson SA: Intravenous infusion of irrigating fluids containing glycine or mannitol with and without ethanol. J Urol 1989;142:1102-1105.
19.
Nilsson A, Randmaa I, Hahn RG: Haemodynamic effects of irrigating fluids studied by Doppler ultrasonography in volunteers. Br J Urol 1996;77:541-546.
20.
Hahn RG, Stalberg HP, Ekengren J, Rundgren M: Effects of 1.5% glycine solution with and without ethanol on the fluid balance in elderly men. Acta Anaesthesiol Scand 1991;35:725-730.
21.
Sandfeldt L, Hahn RG: Comparison of urological irrigating fluids containing glycine and mannitol in volunteers. Prostate 1999;41:89-98.
22.
Still JA, Modell JH: Acute water intoxication during transurethral resection of the prostate, using glycine solution for irrigation. Anesthesiology 1973;38:98-99.
23.
Henderson DJ, Middleton RG: Coma from hyponatremia following transurethral resection of the prostate. Urology 1980;15:267-271.
24.
Charlton AJ: Cardiac arrest during transurethral prostatectomy after absorption of 1.5% glycine. Anaesthesia 1980;35:804-806.
25.
Radal M, Bera AP, Leisner C, Haillot O, Autret-Leca E: Effets indésirables des solutions d'irrigation glycollées. Therapie 1999;54:233-236.
26.
Hultén J: How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method. BJU Int 2002;90:244-247.
27.
Hahn RG, Ekengren J: Patterns of irrigating fluid absorption during transurethral resection of the prostate as indicated by ethanol. J Urol 1993;149:502-506.
28.
Olsson J, Nilsson A, Hahn RG: Symptoms of the transurethral resection syndrome using glycine as the irrigant. J Urol 1995;154:123-128.
29.
Hahn RG, Shemais H, Essén P: Glycine 1.0% versus glycine 1.5% as irrigating fluid during transurethral resection of the prostate. Br J Urol 1997;79:394-400.
30.
Hahn RG, Sandfeldt L, Nyman CR: Double-blind randomized study of symptoms associated with absorption of glycine 1.5% or mannitol 3% during transurethral resection of the prostate. J Urol 1998;160:397-401.
31.
Inman RD, Hussain Z, Elves AWS, Hallworth MJ, Jones PW, Coppinger SWV: A comparison of 1.5% glycine and 2.7% sorbitol-0.5% mannitol irrigants during transurethral prostate resection. J Urol 2001;166:2216-2220.
32.
Collins JW, MacDermott S, Bradbrook RA, Drake B, Keeley FX, Timoney AG: The effect of the choice of irrigation fluid on cardiac stress during transurethral resection of the prostate: a comparison between 1.5% glycine and 5% glucose. J Urol 2007;177:1369-1373.
33.
Yousef AA, Suliman GA, Elashry OM, Elsharaby MD, Elgamasy AEK: A randomized comparison between three types of irrigating fluids during transurethral resection in benign prostatic hyperplasia. BMC Anesthesiol 2010;10:7.
34.
Akan H, Sarghin S, Türkseven F, Yazicioglu A, Cetin S: Comparison of three different irrigation fluids used in the transurethral prostatectomy based on plasma volume expansion and metabolic effects. Br J Urol 1996;78:224-227.
35.
Hahn RG: Hallucination and visual disturbances during transurethral prostatic resection. Intensive Care Med 1988;14:668-671.
36.
Russell D: Painless loss of vision after transurethral resection of the prostate. Anaesthesia 1990;45:218-221.
37.
Mizutani AR, Parker J, Katz J, Schmidt J: Visual disturbances, serum glycine levels and transurethral resection of the prostate. J Urol 1990;144:697-699.
38.
Mantha S, Rao SM, Singh AK, Mohandas S, Prakash Rao BS, Joshi N: Visual evoked potentials and visual acuity after transurethral resection of the prostate. Anaesthesia 1991;46:491-493.
39.
Hahn R, Andersson T, Sikk M: Eye symptoms, visual evoked potentials and EEG during intravenous infusion of glycine. Acta Anaesthesiol Scand 1995;39:214-219.
40.
Nilsson A, Hahn RG: Mental status after transurethral resection of the prostate. Eur Urol 1994;26:1-5.
41.
Hahn RG, Sandfeldt L: Blood ammonia levels after intravenous infusion of glycine with and without ethanol. Scand J Urol Nephrol 1999;33:222-227.
42.
Roesch R, Stoelting RK, Lingeman JE, Kahnoski RJ, Backes J, Gephardt SA: Ammonia toxicity resulting from glycine absorption during a transurethral resection of the prostate. Anesthesiology 1983;58:577-579.
43.
Ryder KW, Olson JF, Kahnoski R, Karn RC, Oei TO: Hyperammonemia after transurethral resection of the prostate: a report of 2 cases. J Urol 1984;132:995-997.
44.
Stalberg HP, Hahn RG, Hjelmqvist H, Ullman J, Rundgren M: Haemodynamics and fluid balance after intravenous infusion of 1.5% glycine in sheep. Acta Anaesthesiol Scand 1993;37:281-287.
45.
Rundgren M, Hjelmqvist H, Gunnarsson U, Hahn RG: Intracerebroventricular infusion of glycine stimulates vasopressin release in conscious sheep. Neuroreport 1993;4:1052-1054.
46.
Hahn RG, Rundgren M: Vasopressin responses during transurethral resection of the prostate. Br J Anaesth 1989;63:330-336.
47.
Hahn RG, Stalberg HP, Gustafsson SA: Vasopressin and cortisol levels in response to glycine infusion. Scand J Urol Nephrol 1991;25:121-123.
48.
Hahn RG: Dose-dependent half-life of glycine. Urol Res 1993;21:289-291.
49.
Hahn RG, Essén P, Wernerman J: Amino acid concentrations in plasma and skeletal muscle after transurethral resection syndrome. Scand J Urol Nephrol 1992;26:235-239.
50.
Hahn RG, Essén P: ECG and cardiac enzymes after glycine absorption in transurethral prostatic resection. Acta Anaesthesiol Scand 1994;38:550-556.
51.
Masloff JI, Milam JH, Bunts RC: Fluid and electrolyte changes associated with transurethral prostatic resection. South Med J 1966;59:1203-1208.
52.
Hahn RG, Farahmand BY, Hallin A, Hammar N, Persson PG: Incidence of acute myocardial infarction and cause-specific mortality after transurethral treatments of prostatic hypertrophy. Urology 2000;55:236-240.
53.
Hammarsten J, Hogstedt B: Clinical, anthropometric, metabolic and insulin profile of men with fast annual growth rates of benign prostatic hyperplasia. Blood Press 1999;8:29-36.
54.
Piros D, Fagerström T, Collins JW, Hahn RG: Glucose as a marker of fluid absorption in bipolar transurethral surgery. Anesth Analg 2009;109:1850-1855.
55.
Fagerström T, Nyman CR, Hahn RG: Complications and clinical outcome 18 months after bipolar and monopolar transurethral resection of the prostate. J Endourol 2011;25:1043-1049.
56.
Singh H, Desai MR, Shrivastav P, Vani K: Bipolar versus monopolar transurethral resection of the prostate: randomized controlled study. J Endourol 2005;19:333-338.
57.
Ran L, He W, Zhu X, Zhou Q, Gou X: Comparison of fluid absorption between transurethral enucleation and transurethral resection for benign prostate hyperplasia. Urol Int 2013;91:26-30.
58.
Ekengren J, Hahn RG: Complications during transurethral vaporization of the prostate. Urology 1996;48:424-427.
59.
Hermanns T, Fankhauser CD, Hefermehl LJ, Kranzbühler B, Wong L-M, Capol JC, Zimmermann M, Sulser T, Müller A: Prospective evaluation of irrigating fluid absorption during pure transurethral bipolar plasma vaporization of the prostate using expired-breath ethanol measurements. BJU Int 2013;112:647-654.
60.
Neyer M, Reissigl A, Schwab C, Pointner J, Abt D, Bachmayer C, Schmid H-P, Engeler DS: Bipolar versus monopolar transurethral resection of the prostate: results of a comparative, prospective bicenter study - perioperative outcome and long-term efficacy. Urol Int 2013;90:62-67.
61.
Fung BT, Li SK, Yu CF, Lau BE, Hou SS: Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate. Asian J Surg 2005;28:24-28.
62.
de Sio M, Autorino R, Quarto G, Damiano R, Perdonà S, di Lorenzo G, Mordente S, D'Armento M: Gyrus bipolar versus standard monopolar transurethral resection of the prostate: a randomized prospective trial. Urology 2006;67:69-72.
63.
Patankar S, Jamkar A, Dobhada S, Gorde V: PlasmaKinetic Superpulse transurethral resection versus conventional transurethral resection of the prostate. J Endourol 2006; 20:215-219.
64.
Mamoulakis C, Ubbink DT, de la Rosette JJ: Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol 2009;56:798-809.
65.
Burke N, Whelan JP, Goeree L, Hopkins RB, Campbell K, Goeree R, Tarride J-E: Systematic review and meta-analysis of transurethral resection of the prostate versus minimally invasive procedures for the treatment of benign prostatic obstruction. Urology 2010;75:1015-1022.
66.
Drobin D, Hahn RG: Kinetics of isotonic and hypertonic plasma volume expanders. Anesthesiology 2002;96:1371-1380.
67.
Hahn RG, Nilsson A, Ståhle L: Distribution and elimination of the solute and water components of urological irrigating fluids. Scand J Urol Nephrol 1999;33:35-41.
68.
Scheingraber S, Rehm M, Sehmisch C, Finisterer U: Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999;90:1265-1270.
69.
Stenvinkel P, Saggar-Mailk AK, Alvestrand A: Renal haemodynamics and tubular sodium handling following volume expansion with sodium chloride (NaCl) and glucose in healthy humans. Scand J Clin Lab Invest 1992;52:837-846.
70.
Chowdhury AH, Cox EF, Francis ST, Lobo DN: A randomized, controlled, double-blind crossover study on the effects of 2-l infusions of 0.9% saline and Plasma-Lyte 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 2012;256:18-24.
71.
Williams EL, Hildebrand KL, McCormick SA, Bedel MJ: The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg 1999;88:999-1003.
72.
Wilkes NJ, Woolf R, Mutch M, Mallett SV, Peachey T, Stephens R, Mythen MG: The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001;93:811-816.
73.
Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, Kellum JA: Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg 2012;255:821-829.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
