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Glycine Irrigation Solution

Glycine Irrigation Solution: Comprehensive Guide to Its Medical Uses and Safety

Introduction

In the realm of surgical procedures, particularly in urology and gynecology, Glycine Irrigation Solution plays a vital role. This non-electrolyte, hypotonic fluid is widely utilized to facilitate clear visualization during endoscopic procedures such as transurethral resection of the prostate (TURP) and hysteroscopy. Its compatibility with the human body and non-conductive properties make it a preferred irrigation medium in scenarios where electrocautery is involved. Despite its widespread application, Glycine Irrigation Solution is not without risks, especially when absorbed in large volumes. Understanding its chemical properties, indications, mechanism of action, benefits, and potential complications is essential for both medical professionals and informed patients.

1. Glycine Irrigation Solution

Glycine Irrigation Solution is a sterile, nonpyrogenic solution containing 1.5% glycine in water. Glycine is a non-essential amino acid that the body uses for a variety of biochemical processes. The solution is hypotonic (i.e., has a lower osmolarity than blood plasma), which facilitates water movement and clearance of debris during surgical procedures.

Composition:

  • Glycine: 1.5 g per 100 mL (15 mg/mL)

  • Water for Injection

  • No preservatives or added electrolytes

It is important to note that the lack of electrolytes makes glycine solution non-conductive, making it particularly suitable for use with monopolar electrosurgical instruments.

2. Mechanism of Action

The primary role of Glycine Irrigation Solution is to irrigate or flush out tissues during endoscopic procedures. During procedures like TURP or hysteroscopy, continuous fluid irrigation is necessary to:

  • Maintain a clear visual field

  • Remove blood, tissue debris, and clots

  • Prevent tissue desiccation

  • Enable hemostasis with monopolar cautery

Its hypotonic nature allows for rapid fluid absorption, which helps clear the field but can also pose risks of fluid overload and electrolyte disturbances if large volumes are absorbed intravascularly.

Glycine, being a naturally occurring amino acid, is metabolized in the liver, converted to ammonia and serine, and subsequently utilized or excreted.

3. Medical Uses and Indications

1. Transurethral Resection of the Prostate (TURP)

TURP is a common procedure for benign prostatic hyperplasia (BPH). Glycine is used as an irrigant during TURP to keep the bladder clear and enable the surgeon to visualize the operative field. The solution also serves as a non-conductive medium, which is crucial when monopolar electrosurgery is employed.

2. Hysteroscopy

During diagnostic and operative hysteroscopy, glycine irrigation helps distend the uterine cavity and provides a clear view of intrauterine structures. Its non-electrolytic nature is beneficial in reducing the risk of electrolyte shifts and allows for electrosurgical cutting or coagulation.

3. Other Endoscopic Procedures

Glycine solution may be used in other procedures such as:

  • Cystoscopy

  • Ureteroscopy

  • Bladder tumor resection

  • Resection of urethral strictures

In all these cases, glycine serves the purpose of continuous flushing and maintaining optical clarity.

4. Advantages of Glycine Irrigation Solution

  • Non-conductive: Suitable for electrosurgical instruments

  • Sterile and Pyrogen-free: Reduces risk of infection

  • Clear and colorless: Enhances endoscopic visibility

  • Hypotonic: Efficient flushing of blood and tissue

  • Physiologically metabolizable: Glycine is naturally processed by the body

  • Low cost: Compared to some other irrigation fluids

5. Risks and Complications

While glycine irrigation solution is generally safe when used appropriately, its use is not without risk. The most serious complications arise from fluid absorption, especially during prolonged procedures.

1. TURP Syndrome

One of the most feared complications during TURP using glycine is TURP syndrome, a life-threatening condition caused by:

  • Excessive absorption of hypotonic fluid

  • Hyponatremia (low blood sodium levels)

  • Fluid overload

Symptoms include:

  • Nausea and vomiting

  • Headache

  • Confusion or restlessness

  • Visual disturbances (due to glycine’s effect on the retina)

  • Seizures

  • Bradycardia and hypertension

Management includes stopping the procedure, administering hypertonic saline, and managing electrolyte imbalances.

2. Hyperammonemia and CNS Toxicity

Glycine is metabolized into ammonia, and excessive absorption can cause elevated plasma ammonia levels, leading to central nervous system toxicity. This is more likely in patients with liver dysfunction.

3. Hemolysis

Due to its hypotonic nature, glycine can cause hemolysis if it enters the bloodstream in large amounts.

4. Cardiac Arrhythmias

Fluid overload and electrolyte imbalances can lead to bradycardia, hypertension, or cardiac arrhythmias.

6. Safety and Monitoring

To prevent complications, careful monitoring during surgery is essential.

Preoperative Measures

  • Evaluate renal and liver function

  • Identify patients at risk for fluid overload

  • Use minimal necessary volumes

Intraoperative Monitoring

  • Monitor fluid input and output

  • Limit procedure time (ideally <60 minutes for TURP)

  • Use pressure bags cautiously

  • Keep inflow pressure low

Postoperative Monitoring

  • Watch for signs of TURP syndrome

  • Check serum sodium, osmolality, and ammonia levels if symptoms arise

  • Monitor neurologic and cardiovascular status

7. Alternatives to Glycine Irrigation

Due to the risk of complications with glycine, several alternatives are now used, especially with bipolar electrosurgical systems that do not require non-conductive irrigation fluids:

  • Normal Saline (0.9%): Isotonic, safe, and effective with bipolar instruments

  • Sorbitol 3% Solution: Also non-conductive and metabolized in the liver

  • Mannitol 5%: Used when glycine or sorbitol are contraindicated

These fluids may be preferred depending on the type of surgery and equipment used.

8. Glycine in the Body: Metabolism and Excretion

Glycine is a naturally occurring non-essential amino acid involved in:

  • Collagen synthesis

  • Neurotransmission

  • Detoxification

  • Heme production

After absorption, glycine is:

  • Metabolized in the liver into ammonia and serine

  • Used in various biochemical pathways

  • Excreted by the kidneys

In the context of glycine irrigation, most of the glycine is absorbed passively into systemic circulation. The body can generally metabolize small amounts safely, but complications can arise with larger systemic absorption, especially in long surgeries or those with open venous sinuses.

9. Dosage and Administration

Glycine Irrigation Solution is not administered intravenously but used only for continuous bladder or uterine irrigation. It comes in large-volume containers (e.g., 1,000 mL or 3,000 mL bags) and is typically delivered via a gravity-fed system or pressure bags to facilitate controlled flow during procedures.

The volume used depends on the length and complexity of the procedure. Strict attention must be paid to:

  • Influx and efflux volumes

  • Fluid deficit monitoring (fluid retained in the body vs. fluid returned)

10. Storage and Handling

  • Store at controlled room temperature (20–25°C)

  • Avoid freezing

  • Use aseptic technique to prevent contamination

  • Once opened, the solution should be used immediately or discarded

Conclusion

Glycine Irrigation Solution remains a cornerstone in endoscopic urological and gynecological procedures, valued for its non-conductive, clear, and low-cost characteristics. Its widespread use in TURP and hysteroscopy has revolutionized intraoperative visibility and electrosurgical compatibility. However, like all medical interventions, it comes with inherent risks, most notably TURP syndrome, fluid overload, and electrolyte disturbances. Understanding these risks and implementing strict perioperative monitoring protocols ensures that glycine irrigation can be used safely and effectively. As surgical technology evolves and bipolar energy systems become more common, the role of glycine may decrease in favor of safer isotonic alternatives like normal saline. Still, its legacy and continued utility in modern medicine remain significant.