Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. II. Isotonic 2.2% glycine solution as an irrigating fluid.

Seventeen patients undergoing transurethral resection of the prostate using isotonic 2.2% glycine solution as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water, and the concentrations of electrolytes and free amino acids in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2, 6, 24 and 48 hours postoperatively in two groups with separate sampling periods. There were no significant changes in water content and sodium or chloride concentrations in muscle tissue postoperatively. Potassium and magnesium concentrations decreased late in the postoperative phase. In plasma there was a fifty-fold increase immediately postoperatively in the glycine concentration (mean fluid absorption 0.71) followed by a six-fold increase in muscle tissue 6 hours postoperatively. The glycine metabolite serine also increased in plasma and muscle. Other muscle amino acid concentrations decreased immediately postoperatively probably due to the massive glycine entrance into the cells. Later postoperative changes in some muscle amino acids (glutamine, glutamate, alanine, tyrosine and arginine) may be explained more by the operative trauma than by the influence of glycine. Two different types of metabolic effects are seen in this material. The first is that of the glycine infusion and the metabolic effects of glycine. The second is the catabolic influence of the surgical trauma. Accumulation of glycine in tissues in some patients with the possible production of ammonia and the effects of glycine as an inhibitory neurotransmitter must be considered as risk factors when choosing glycine as an irrigating fluid.