Transurethral Resection Syndrome Research Articles

Glycine and transurethral resection

Fifty patients undergoing transurethral resection of the prostate were studied for evidence of glycine absorption and haemodilution. Plasma glycine levels increased substantially in nine patients and, in five, calculated irrigant fluid absorption ranged from 619-1582 ml; another patient had absorbed 1360 ml fluid with only a small rise in plasma glycine. Two illustrative case histories are presented. The role of glycine as an inhibitory neurotransmitter is discussed and the possibility of toxic mechanisms other than dilutional hyponatraemia is mentioned. Intravenous diuretics, hypertonic saline, and perhaps calcium salts, are recommended for the overt transurethral resection syndrome.

Absorption of 1.5% Glycine after Percutaneous Ultrasonic Lithotripsy for Renal Stone Disease

An elderly normotensive man underwent percutaneous ultra? sonic lithotripsy for renal stone disease, the procedure lasting three hours and the fragments being washed out with 20 1 1-5% glycine. After two hours the inflation pressure had risen to 25 cm H20 and his blood pressure to 150 mm Hg. Inflation pressure continued to rise until drainage tubes were inserted into the retroperitoneal space, releasing a large volume of fluid, some of which appeared to be from the peritoneal cavity. Shortly after transfer to the recovery area the patient showed signs of the transurethral resection syndrome, with hyponatraemia, hyper kalaemia, and hypertension. He was treated appropriately and survived. Low infusion pressures should be used for irrigation during lithotripsy and 0-9% saline instead of 1-5% glycine. In patients given a general anaesthetic any rise in inflation pressure suggests extravasation of fluid and warrants emergency estimation of the plasma sodium concentration.

Effects of Glycine on Hemodynamic Responses and Visual Evoked Potentials in the Dog

To study the potential contribution of glycine toxicity in the transurethral resection syndrome, we evaluated hemodynamic and visual evoked potential responses to glycine infusion (1 g/kg) in 22 dogs anesthetized with halothane (1.0-1.2% end tidal. Three dogs received 5% glucose in normal saline without glycine; three received arginine (4 mg/kg) in normal saline without glycine; three received arginine (4 mg/kg) in normal saline without glycine; 10 received glycine (1 g/kg), then arginine (4 mg/kg) 120 min after the completion of glycine infusion; and six received arginine 30 min after the completion of glycine infusion. Arginine was infused to evaluate potential antagonistic effects of glycine toxicity. Blood levels of glycine, ammonia, arginine, urea, and formate were determined after infusions of glycine or arginine. All animals received about 5 ml X kg-1 X hr-1 of normal saline during the 2-4 hr of study. Immediately after glycine infusion, cardiac output increased 57%, whereas systemic vascular resistance and mean arterial pressure decreased 32% and 8%, respectively. Later cardiac output and mean arterial pressure were 41% and 18% less than control levels, whereas systemic vascular resistance returned to control levels. Both amplitude and latency of visual evoked potential waveforms were altered in the animals receiving glycine infusion but not in the control animals. These responses were associated with elevations of blood glycine (149 +/- 5 to 9591 +/- 809 microM/L, mean + SEM) and blood NH3 (10.5 +/- 2.8 to 100.0 +/- 13.6 microM/L), but not with formate levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Transurethral Prostatic Resection with Suprapubic Trocar Technique

The use of a suprapubic trocar in transurethral prostatic resection was evaluated between 1975 and 1982. Of 884 transurethral prostatic resections performed 577 were done using the trocar, and 307 using the conventional filling and emptying technique. There was no difference in operative time when resecting small glands. All large glands (more than 30gm.) were resected using the trocar technique. Severe cases of the so-called transurethral resection syndrome have been eliminated completely by this procedure. The blood loss was slightly higher when the trocar technique was used, probably because of the low pressure in the prostatic fossa during resection. We recommend the trocar in transurethral prostatic resection, since it facilitates the procedure by allowing uninterrupted resection, keeps the bladder pressure low and, thereby, minimizing the amount of absorbed irrigating fluid, and has practically no complications.

Percutaneous Ultrasonic Lithotripsy: Choice of Irrigant

Extravasation of glycine irrigant during percutaneous ultrasonic lithotripsy has caused a transurethral resection syndrome consisting of hypertension, confusion and hyponatremia. With a rabbit model this complication is recreated with the intraperitoneal instillation of 1.5 per cent glycine solution tagged with 14carbon-glycine. Significant quantitative absorption of glycine into blood and other organs is demonstrated. A review of the literature reveals few guidelines as to the choice of irrigant for intrarenal endoscopy. Since this procedure involves no electric current it is suggested that physiological saline rather than glycine be used for ultrasonic stone disintegration.

Transurethral Prostatic Resection Syndrome—A New Perspective: Encephalopathy with Associated Hyperammonemia

AbstractEncephalopathy developed in 3 patients after transurethral prostatic resection. Each patient had blood ammonia levels more than 10 times the upper limit of normal. Data supportive of a metabolic cause for encephalopathy subsequently were obtained in a prospective study of patients undergoing transurethral prostatic resection with glycine irrigation. It is suggested that a distinct subpopulation of patients experiencing transurethral prostatic resection syndrome can be identified. These patients exhibit encephalopathic symptoms and have concurrent marked elevation of blood ammonia levels.

Intravesical pressure during transurethral resection using Iglesias resectoscope with continuous irrigation and suction.

Intravesical pressure was studied in 20 patients during transurethral resection (TUR) of the prostate using the Iglesias resectoscope with continuous irrigation and suction. The suction pressure (50 cm H20) was considerably lower than that suggested by Iglesias. The amount of irrigant was thereby appreciably diminished and blocking of the outlet system was avoided. The intravesical pressure averaged 35 cm H20 during resection, which is less than in conventional resection, and 15 cm during evacuation of tissue chips. Signs of TUR syndrome were not seen. We consider the new resectoscope to be a considerable improvement for TUR.

Hydraulic Hemostasis in Transurethral Resection of the Prostate Using the Iglesias Continuous Suction Resectoscope

An intravesicoprostatic hydrostatic pressure less than 10 mm. Hg maintains normal anatomy and physiology of the muscular and vascular prostatic structures. An increase in hydrostatic intravesicoprostatic pressure to more than 10 mm. Hg produces a distortion in the musculature of the prostate, especially at the true capsule, opening the cut vessels and making possible the absorption of the irrigant free of electrolytes (transurethral resection syndrome). A low hydrostatic intravesicoprostatic pressure permits the compression of cut vessels by the inflow hydraulic pressure of 90 cm. water, achieving hydraulic hemostasis during transurethral resection of the prostate. Less electrocoagulation is necessary, resulting in more rapid patient recovery.

Morbidity and early outcome of transurethral resection of prostate: A prospective single-institute evaluation of 100 patients

Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications. The objective of the study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute. We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient. The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67 gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88 ml per second from 9.24 ml per second and average fl ow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46 ml from preoperative 86.59 ml. TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate.