SPC v TURP for elderly polymorbid man

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
  • Parkinson’s
  • Cerebral Amyloid Angiopathy
  • ECG in clinic showed bradycardia, P-waves present. Possible trifasicular block. Asymptomatic.



  • 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