• Muhammad Tousif Pasha
  • Musharraf Ali Khan
  • Yasir Jamal
  • Fazle Wahab
  • Hamza Ashraf
  • Naeem ullah


Background: Transurethral resection of prostate (TURP) is considered the gold standard for the surgical treatment of BPH. Irrigant fluid absorption by the patient is a potentially serious complication of TURP and can lead to dilutional hyponatremia and TURP syndrome. Other common complications of TURP include urinary tract infection and secondary haemorrhage. The objective of this study was to compare the frequency of postoperative complications (Urinary Tract infection and dilutional hyponatremia) between 1.5% glycine and sterile distilled water used as irrigant in BPH patients after TURP. Methods: This randomized controlled trial was conducted in department of Urology, PIMS Islamabad, from August 2013 to February 2014. A total of 170 adult male patients between 50-80 years of age undergoing TURP with prostate volume more than 30cc on ultrasound. 85 patients each were randomly allocated to two groups. In group-A, glycine was used as irrigant solution during TURP while in group-B distilled water was used. Serum sodium levels were measured at 6th postoperative hour to look for dilutional hyponatremia. On the 15th postoperative day they were inquired about any clinical features of urinary tract infection. Also urine routine examination was performed to look for the presence of WBCs in the urine. Results: Post-operative dilutional hyponatremia was observed in 13 (15.3%) patients in Group A and in 10 (11.8%) patients in group-B. The difference between both the groups being non-significant (p-value=0.501).Frequency of postoperative urinary tract infection on 15th postoperative day in group-A was 23(27.1%) while in group-B it was 16 (18.8%), the difference among both the groups being insignificant (p-value=0.202). Conclusion: Although the frequency of postoperative complications like UTI and dilutional hyponatremia was less with sterile distilled water, yet, the difference was statistically not significant.Keyword: TURP, Benign Prostatic hyperplasia, Irrigant solutions, Dilutional Hyponatremia, Urinary Tract Infection


Bozdar HR, Memon SR, Paryani JP. Outcome of Transuretheral Resection of Prostate in Clinical Benign Prostatic Hyperplasia. J Ayub Med Coll Abbottabad 2010;22:194–6.

Jalbani MH, Memon SR, Dinari RA, Shaikh NA, Oad AK, Rohra KC. Effects of Transurethral Resection of Prostate on Flow Rate and Voided Volume on Patients with Benign Prostatic Hyperplasia. J Liaquat Uni Med Health Sci 2009;8:146–9.

Gupta K, Rastogi B, Jain M, Gupta PK, Sharma D. Electrolyte Changes: An Indirect Method to Assess Irrigation Fluid Absorption Complications During Transurethral Resection of Prostate: A Prospective Study. Saudi J Anaesth 2010;4:142–6.

Chen SS, Wu SB, Wei YH. The difference in oxidative stress of the blood between using 5% glucose water and distilled water as the irrigant for BPH patients undergoing transurethral resection of the prostate. World J Urol 2010;28:33–7.

Collins JW, MacDermott S, Bradbrook RA, Drake B, Keeley FX, Timoney AG. 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. J Urol 2007;177:1369–73.

Lv L, Wang L, Fan M, Ju W, Pang Z, Zhu Z, et al. Two-year Outcome of High-risk Benign Prostate Hyperplasia Patients Treated With Transurethral Prostate Resection by Plasmakinetic or Conventional Procedure. Urology 2012;80(2):389–94.

Muhammad AT, Shaikh AA, Devrajani BR, Shah ZA, Das T, Singh D. Serum Sodium Level in Transurethral Resection of the Prostate (TURP) (a cross sectional descriptive study at two hospitals). Med Channel 2010;16(2):318–20.

Mogensen K , Jacobsen JD. The load on family and primary healthcare in the first six weeks after transurethral resection of the prostate. Scand J Urol Nephrol 2008;42(2):132–6.

Alhasan SU, Aji SA, Mohammed AZ, Malami S. Transurethral resection of the prostate in Northern Nigeria, problems and prospects. BMC Urol 2008;8:18.

Moharari RS, Khajavi MR, Khademhosseini P, Hosseini SR, Najafi A. Sterile water as an irrigating fluid for transurethral resection of the prostate: anesthetical view of the records of 1600 cases. South Med J 2008;101(4):373–5.

Memon NA. Mineral Water as an Irrigating Fluid During Transurethral Resection of Prostate. Pak J Surg 2007;23:275–8.

Suhani, Gupta S, Gupta A, Saha S, Mahapatra L, Srivastava UK. Outcome of Surgery for Benign Prostatic Hyperplasia-Is It Predictable?. J Clin Diagn Res 2013;7(12):2859–62.

Levy A, Samraj GP. Benign Prostatic Hyperplasia: When to “Watch and Wait”, When and How to Treat. Cleve Clin J Med 2007;74 Suppl 3:S15–20.

La Vecchia C, Levi F, Lucchini F. Mortality from benign prostatic hyperplasia: worldwide trends 1950-92. J Epidemiol Community Health 1995;49(4):379–84.

Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7 Suppl 9:S3–S14.

Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate 1990;17(3):241–6.

Cunha GR, Ricke WA. A historical perspective on the role of stroma in the pathogenesis of benign prostatic hyperplasia. Differentiation 2011;82(4-5):168–72.

McConnell JD. The pathophysiology of benign prostatic hyperplasia. J Androl 1991;12(6):356–63.

Deering RE, Bigler SA, King J, Choongkittaworn M, Aramburu E, Brawer MK. Morphometric quantitation of stroma in human benign prostatic hyperplasia. Urology 1994;44(1):64–70.

Rohr HP, Bartsch G. Human benign prostatic hyperplasia: a stromal disease? New perspectives by quantitative morphology. Urology. 1980; 16(6):625–33.

El-Hakim A. TURP in the new century: an analytical reappraisal in light of lasers. Can Urol Assoc J 2010;4(5):347–9.

Aisuodionoe-Shadracha OI, Akporiaye LE. Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria. Afr. J. Urol 2013;19:22–5.

Kim JH, Park JY, Shim JS, Lee JG, Moon du G, Yoo JW et al. Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-centre study. Can Urol Assoc J 2014; 8(1-2):E30–5.

O’Donnell AM, Foo ITH. Anaesthesia for transurethral resection of the prostate. Continuing Education in Anaesthesia, Critical Care & Pain 2009;9:92–6.

Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 1989;141(2):243–7.

Uchida T, Ohori M, Soh S, Sato T, Iwamura M, Ao T, et al. Factors influencing morbidity in patients undergoing transurethral resection of the prostate. Urology 1999;53(1):98–105.

Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Urology Section of the Bavarian Working Group for Quality Assurance. . Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008;180(1):246–9.

Fung BT, Li SK, Yu CF, Lau BE, Hou SS. Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate. Asian J Surg 2005;28(1):24–8.

Al-Abbadi BA, Al-Hammori FA, Abo Gamar AA, Saed ZM. Transurethral Resection of Prostate: The Standard Surgical Intervention for Benign Prostatic Hyperplasia. JRMS 2010;17(4):28–34.

Liu GG, Nguyen T, Nichol MB. An economic analysis of antimicrobial prophylaxis against urinary tract infection in patients undergoing transurethral resection of the prostate. Clin Ther 1999; 21(9):1589–604.

Lawson KA, Rudzinski JK, Vicas I, Carlson KV. Assessment of antibiotic prophylaxis prescribing patterns for TURP: A need for Canadian guidelines?. Can Urol Assoc J 2013;7(7-8):E530–6.

Rassweiler J, Teber D, Kuntz R, Hofmann R.Complications of transurethral resection of the prostate (TURP)-incidence, management, and prevention. Eur Urol 2006;50(5):969–79.

Colau A, Lucet JC, Rufat P, Botto H, Benoit G, Jardin A. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. Eur Urol 2001;39(3):272–6.

Ketabchi AA, Ketabchi M, Barkam M. The Effect of Modified TURP (M-TURP) in Intra and Postoperative Complications. Nephrourol Mon 2013;5(2):758–61.

Lim KB, Wong MY, Foo KT. Transurethral resection of prostate (TURP) through the decades--a comparison of results over the last thirty years in a single institution in Asia. Ann Acad Med Singapore 2004;33(6):775–9.

Vivien A, Lazard T, Rauss A, Laisné MJ, Bonnet F. Infection after transurethral resection of the prostate: variation among centers and correlation with a long-lasting surgical procedure. Association pour la Recherche en Anesthésie-Réanimation. Eur Urol 1998;33(4):365–9.

Moorthy HK, Philip S. Serum Electrolytes In Turp Syndrome-Is The Role Of Potassium Under-Estimated?. Indian J Anaesth 2002;46(6):441–5.




Most read articles by the same author(s)