Acute tubular necrosis following transurethral resection of the Prostate using Glycine as irrigating fluid

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Published Nov 15, 2017
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Vol. 95 No. 2 (2017): Issue Feb 2017

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Lamia Rais
Zohra El Ati
Lilia Ben Fatma
Rania Kheder
Hela Jebali
Wided Smaoui
Madiha Krid
Fethi Ben Hamida
Fatma Ben Moussa
Soumaya Beji
Mohamed Karim Zouaghi

Abstract

Transurethral resection of the prostate is currently the gold standard for the surgical treatment of the benign prostatic hyperplasia. This surgery
may lead transurethral resection of the prostate (TURP) syndrome and in some cases, acute tubular necrosis can develop. We report a patient
who developed hyponatremia, hemolysis and oliguric acute renal failure as a major complication following TURP using glycine as irrigating fluid.A
64-year-old man was admitted for a prostate resection procedure. Physical examination revealed a healthy elderly man. Preoperative laboratory
data showed serum sodium 140 mEq/L, blood urea nitrogen (BUN) 0.6 g/L, creatinine 0.7 mg/dL and hemoglobin 12.9 g/dL. Few hours after,
the patient becomes incoherent and developed oliguria, nausea and vomiting. The laboratory data revealed rapidly elevating BUN and creatinine
levels (BUN 2.4 g/L; creatinine 6.1 mg/dL), the serum sodium concentration decreased by 14 meq/L. A decreased hemoglobin level (7.4 g/dL)
with an elevated lactate dehydrogenase level (665 U/L) was observed. Renal ultrasonography was normal. The diagnosis of acute tubular
necrosis complicating TURP syndrome was retained. The hyponatremia was slowly corrected to 132 mmol/L by diuresis and fluid restriction. The
renal function recovered after four hemodialysis sessions. Using glycine as an irrigant for TURP may cause hyponatremia, hemolysis and also
acute renal failure, especially in patients with longer resection time. It is necessary to carry out every effort to shorten resection time and avoid
extravasation during surgery.

Keywords:

Transurethral Resection of Prostate, Hyponatremia, Hemolysis, Renal Insufficiency

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