Correlation between Volume of Glycine Used as Irrigating Fluid and Serum Sodium Level during Transurethral Resection of the Prostate [TURP]

Document Type : Original Article

Authors

1 Department of Anesthesia, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt

2 Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Benign prostatic hyperplasia causes bothersome lower urinary tract symptoms like urinary frequency, urgency, intermittency and weak urine flow due to symptomatic bladder outlet obstruction. Transurethral resection of the prostate is the second most common surgery performed in men over 65 years of age. Endoscopic procedures in the urinary system require the use of irrigating fluids.
Aim of the Study: The aim of this study was to evaluate changes in serum sodium levels with the use of 1.5% glycine solution as the irrigating fluid during transurethral resection of the prostate as the primary outcome. Secondary outcomes included hemodynamic changes like blood pressure (systolic and diastolic) and heart rate.
Patients and Methods: This prospective analytical study included 50 male patients aged 45-70 years scheduled for elective transurethral resection of the prostate at Al-Azhar Hospitals in Damietta and Cairo, Egypt after obtaining written informed consent.
Results: The median age was 50 years and median weight was 68 kg. The median resected prostate volume was 50 gm, median surgery duration was 100 minutes, and median total volume of irrigation fluid was 2085 ml. There was a statistically significant positive correlation between the total volume of glycine irrigation fluid and sodium levels intraoperatively and postoperatively, especially at 2.5 and 3.5 hours postoperatively (p=0.038, 0.024 respectively). Statistically significant decreases were seen in systolic blood pressure, diastolic blood pressure, and heart rate from preoperative to postoperative parameters. Postoperative hemoglobin, hematocrit, and platelet counts were also significantly lower (p<0.001).
Conclusion: Sodium levels significantly decreased intraoperatively during transurethral resection of the prostate when using glycine as the irrigation fluid, with subsequent hemodynamic and neurological manifestations related to hyponatremia.

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