From the Guidelines
TURP carries a significant cardiac risk, with a reported perioperative mortality of 0.1% and morbidity of 11.1%. The cardiac risk associated with TURP is a critical consideration in the management of patients with benign prostatic hyperplasia (BPH) 1. Several factors contribute to the cardiac risk, including the patient's underlying medical conditions, such as coronary artery disease, heart failure, and cerebrovascular disease.
Key Considerations
- The use of oral anticoagulants or antiplatelet medications preoperatively can lead to longer catheterization and hospitalization times, and higher blood transfusion and re-hospitalization rates 1.
- Bipolar TURP (B-TURP) has a more favorable perioperative safety profile than monopolar TURP (M-TURP), with comparable short-, mid-, and long-term results 1.
- The risk of cardiac complications is increased with longer resection times and larger prostate glands.
Recommendations
- A preoperative cardiac evaluation is recommended for high-risk patients, including ECG, stress testing, and possibly echocardiography.
- Cardiac medications should be continued perioperatively, with careful consideration of the risks and benefits of stopping antiplatelet therapy.
- Intraoperative monitoring for hypotension, bradycardia, and ECG changes is essential to minimize the risk of cardiac complications.
- Postoperatively, patients should be monitored for cardiac complications for 24-48 hours, with special attention to fluid balance, electrolytes, and cardiac symptoms.
From the Research
Turp Cardiac Risk
- The relationship between transurethral resection of the prostate (TURP) and cardiac risk is not directly addressed in the provided studies, but some studies mention complications that may be related to cardiac risk, such as:
- Postoperative sepsis or shock, transfusion, reoperation, and deep vein thrombus or pulmonary embolism, which were associated with longer surgical duration 2
- Clot retention, urethral strictures, and TUR syndrome, which are potential complications of TURP, but not specifically related to cardiac risk 3
- The studies suggest that TURP is a relatively safe procedure, but it is not without risks, and complications can occur, including those related to anesthesia and surgical technique 4, 5
- A study on elderly patients undergoing TURP for chronic urinary retention found that the overall complication rate was 9.5%, but did not specifically address cardiac risk 6
- The provided studies do not offer a direct assessment of cardiac risk associated with TURP, but they do highlight the importance of careful patient selection, proper surgical technique, and anesthesia management to minimize complications 2, 3, 4, 5, 6