Document Detail


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.
MedLine Citation:
PMID:  17382734     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: 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. MATERIALS AND 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.
Authors:
Justin W Collins; Seamus Macdermott; Richard A Bradbrook; Brent Drake; Frank X Keeley; Anthony G Timoney
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of urology     Volume:  177     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-30     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1369-73     Citation Subset:  AIM; IM    
Affiliation:
Bristol Urological Institute, Bristol, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Double-Blind Method
Electrocardiography / drug effects
Glucose / administration & dosage*,  adverse effects
Glycine / administration & dosage*,  adverse effects
Heart / drug effects*
Heart Diseases / blood,  chemically induced
Humans
Irrigation / methods
Male
Middle Aged
Prospective Studies
Stress, Physiological / blood,  chemically induced*
Transurethral Resection of Prostate* / methods
Troponin I / blood
Chemical
Reg. No./Substance:
0/Troponin I; 50-99-7/Glucose; 56-40-6/Glycine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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