87-year-old man. Consult for TURP.
- Bladder outlet obstruction
- ICU admission with urosepsis. IDC since discharge.
- TURP many years ago. Flexible cystoscopy showed regrowth of previous TUR tunnel.
- Patient and urology team keen for him to be catheter-free however patient very willing to have SPC.
- HFrEF 45%
- AF on DOAC. Previous DVT.
- Significant Rheumatoid Arthritis, on long-term steroid therapy
- Idiopathic Pulmonary Fibrosis
- Cerebral Amyloid Angiopathy
- ECG in clinic showed bradycardia, P-waves present. Possible trifasicular block. Asymptomatic.
TURP Vs SPC
- General opinion that there are significant risks for perioperative cardiac and respiratory complications
- Advantages and disadvantages of both options weighed in detail
- It would be ideal for the patient to be catheter-free and a TURP could be done under a spinal
- However, TURP would require much longer period off-anticoagulation and risks of MACE unchanged by mode of anaesthesia