A randomized comparison between three types of irrigating fluids during transurethral resection in benign prostatic hyperplasia.

BACKGROUND: Central nervous system changes, circulatory and electrolyte imbalances are the main complications of endoscopic transurethral resection of the prostate (TURP) which is known as transurethral resection (TUR) syndrome, which occurs as result of excessive absorption of irrigating fluid. We compare glycine 1.5% versus glucose 5% and normal saline 0.9% as irrigating solutions during TURP in patients with moderate to severe bladder outlet obstruction due to benign prostatic hyperplasia (BPH). METHODS: Three hundred sixty patients with symptomatic BPH were randomized into a prospective, controlled trial comparing the three irrigation modalities. One-hundred twenty patients used glycine 1.5% solution as irrigating fluid (glycine group), 120 patients used glucose 5% solution (glucose group) and 120 patients used normal saline 0.9% solution (saline group). Patient's demographics, operation time, hospital stay, postoperative amino acid glycine assay, postoperative serum cardiac troponin I and perioperative complications were noted. RESULTS: No difference was found between the groups in the immediate postoperative levels of hemoglobin and hematocrite. A high glycine level was associated with the TUR syndrome. Seventeen patients had TUR syndrome; all were in glycine group and they had the highest postoperative amino acid glycine levels. Slight increase in serum sodium (142.6 +/- 12.6 mmol/l) was detected in saline group. Transient Hyperglycemia (170 +/- 35.9 mg/dl) and hypokalemia (3.67 +/- 0.92 mmol/l) occurred in the immediate postoperative period in the glucose group. CONCLUSION: Endoscopic TURP performed using either glucose 5% or saline 0.9% irrigating solution during and after surgery is associated with lower incidence of TUR syndrome, lower catheterization period, shorter hospital stay and no cardiac toxicity in comparison with glycine 1.5% solution. TRIAL REGISTRATION: This clinical trail had been approved and registered in PACT Registry; with identification number for the registry is ATMR2010010001793131.

The use of polypropylene mesh as a transobturator sling for the treatment of female stress urinary incontinence (early experience with 40 cases).

This study evaluated the use of traditional polypropylene mesh, used in hernias repair, as a sling in the treatment of female stress urinary incontinence (SUI). Forty patients diagnosed with SUI underwent transobturator sling fashioned from the ordinary polypropylene mesh (vypro II). Each lateral end of the tape is secured by a zero prolene suture. The procedure was then done outside-in, and the patients were followed up. The mean operative time was 40-60 min when the procedure was performed alone or accompanied with associated pelvic floor repair. Thirty-five patients (87.5%) were cured, and two patients (5%) significantly improved, but the procedure failed in three patients (7.5%), and the slings were removed because of vaginal erosion. Polypropylene mesh transobturator sling is an easy and cheap method for the treatment of female SUI with a high success rate.