87-year-old man. Consult for TURP.

Background:

• 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.
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Issues:

• 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.

Discussion:

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