Friday, July 22, 2016

Why use glycine in TURP?

TURP is the current standard surgical procedure for BPH. The various irrigation fluids are

NaCl- since there is use of cautery in TURP.. NaCl can be hazardous to the surgeon as well as the patient

Distilled water- while resection of prostate tissue, there is exposure of the underlying vessels..which leads to rapid absorption of the irrigating fluid. Distilled water is highly hypotonic.. which can cause widespread hemolysis.

Glycine- currently the most preferred agent. The commonly used conc is 1.5% glycine with an osmolality of 230mosmoles(plasma 285-290mosmole) At this conc the hypotonicity is balanced with the toxicity of glycine. Though it can still cause volume overload with dilutional hyponatremia..it is not as severe as with distilled water.

Dilution hyponatremia Is a dreaded complication of TURP. The management includes I.V NaCl solution (0.9% & 3%), fluid restriction and furosemide.

Other less known solutions are- Glucose , mannitol and urea
A costly but comparatively safer option is cytal( sorbitol+mannitol)..but due to cost restriction..it's not that common.


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