Rotational thromboelastometry (ROTEM) based comparison of coagulation parameters in transurethral resection of the prostate surgery using saline versus glycine as an irrigant fluid - A prospective observational comparative study.

Background and Aims: Transurethral resection of the prostate (TURP) is the gold standard for benign prostatic hyperplasia. However, the systemic absorption of irrigation fluids, such as glycine or saline, may affect coagulation. Glycine is associated with dilutional coagulopathy and electrolyte imbalance, while saline offers better stability. Conventional coagulation tests may miss early changes; rotational thromboelastometry (ROTEM) offers dynamic assessment. This study compared the coagulation effects of glycine and saline irrigation using ROTEM to inform safer irrigant selection during TURP. Methods: In this study, 80 males (50-70 years) undergoing TURP were administered glycine (Group G, n = 40) or saline (Group S, n = 40). Coagulation was evaluated pre- and postoperatively via ROTEM (INTEM, EXTEM, and FIBTEM) and conventional tests (haemoglobin, platelets, prothrombin time, and electrolytes). Statistics included t-tests, Mann-Whitney U, and Chi-square (P < 0.05 significant). Results: Glycine significantly prolonged mean INTEM clotting time (CT): 176.05 [standard deviation (SD): 52.97] [95% confidence interval (CI): 160.48, 191.63)] versus 152.58 (SD: 25.23) (95% CI: 144.47, 160.68) (P = 0.013), and reduced mean maximum clot firmness: 55.85 (SD: 15.29) versus 62.73 (SD: 8.60) (P = 0.015). FIBTEM CT and clot formation time were also prolonged in the glycine group (P = 0.013 and P = 0.023, respectively). Postoperative haemoglobin and platelet counts declined in both groups, more so in the glycine group. One patient (2.5%) in Group G developed TUR syndrome. Conclusion: Glycine impairs intrinsic coagulation and fibrin polymerisation more than saline. Saline offers better coagulation profiles. ROTEM-guided protocols may optimise perioperative haemostatic management, especially in high-risk patients.