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.
OBJECTIVE
Variable amounts of irrigation fluid are absorbed during transurethral prostate resection. Previous studies suggest that cardiac stress occurs as a result of transurethral prostate resection, possibly due to glycine absorption. We performed a prospective, blinded, randomized trial comparing 1.5% glycine with 5% glucose irrigating solution. We assessed whether glycine or glucose irrigation for transurethral prostate resection is associated with cardiotoxicity, as measured by troponin I and echocardiogram changes.


METHODS
Between December 2001 and March 2003, 250 patients were recruited. Changes in immediate postoperative vs preoperative echocardiogram and serum cardiac troponin I indicated perioperative myocardial stress. Intraoperative irrigating fluid absorption was measured with 1% ethanol as a marker. Operative details recorded were anesthesia type, resection time, resected tissue weight and temperature change. Blood loss was measured with transfusions considered. Postoperatively blood assessments included serum glycine assay.


RESULTS
Five patients (4%) in the glycine group and 3 (2%) in the glucose group had significantly increased troponin I after surgery. Of these men 1 per group had myocardial infarction and the remainder had transient ischemia. Logistic regression was used to identify factors associated with an unfavorable outcome, which was recorded as a significant increase in troponin I or ischemic changes on echocardiography. Increasing patient age and blood loss were associated with an unfavorable outcome (OR 1.84 and 1.24, respectively). We noted no significant differences in the 1.5% glycine and 5% glucose groups with regard to troponin I/echocardiogram. However, when the glycine assay was compared with adverse outcomes, an increased glycine assay was found to be associated with echocardiogram changes (p = 0.001) and with increased troponin I levels (relative risk 10.71).


CONCLUSIONS
Transurethral prostate resection has an effect on the myocardium perioperatively. Glycine absorption causes echocardiogram changes and it is associated with increased troponin I. Increasing patient age and blood loss are associated with myocardial insult. The risk of increased blood loss was accumulative with each unit lost. Unrecognized blood loss or glycine absorption may explain the increase in morbidity and mortality previously reported in patients who undergo transurethral prostate resection.
Collins
Justin W
JW
Bristol Urological Institute, Bristol, United Kingdom.
Macdermott
Seamus
S
Bradbrook
Richard A
RA
Drake
Brent
B
Keeley
Frank X
FX
Timoney
Anthony G
AG
D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D005998:Glycine / Q000008:administration & dosage* / Q000009:adverse effects; D006321:Heart / Q000187:drug effects*; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013312:Stress, Physiological / Q000097:blood / Q000139:chemically induced*; D007507:Therapeutic Irrigation / Q000379:methods; D020728:Transurethral Resection of Prostate / Q000379:methods; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D005947:Glucose; D005998:Glycine