Mehmood Zabish, Abdullah Muhammad Asad, Sanan Muhammad, Fayyaz Hamna, Ahmad Usama, Iftikhar Alishba, Aslam Farhan, Pervaiz Khanday Saiher
Urology, Sir Ganga Ram Teaching Hospital, Lahore, PAK.
Urology, Bahawal Victoria Hospital, Bahawalpur, PAK.
Cureus. 2025 Aug 15;17(8):e90137. doi: 10.7759/cureus.90137. eCollection 2025 Aug.
Background Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostatic hyperplasia (BPH). However, its safety in high-risk cardiac patients remains a clinical concern, particularly regarding perioperative cardiac complications. Objective To evaluate the intraoperative and postoperative outcomes of TURP under spinal anesthesia in high-risk cardiac patients. Methods This descriptive observational study included 225 male patients aged ≥50 years with documented high-risk cardiac conditions (American Society of Anesthesiologists (ASA) Class III-IV). All underwent TURP under spinal anesthesia at the Department of Urology, Fatima Jinnah Medical University (FJMU)/Sir Ganga Ram Teaching Hospital, Lahore, from February 2023 to August 2023. Data collected included demographic variables, cardiac comorbidities, intraoperative hemodynamic changes, postoperative cardiac events, incidence of TUR syndrome, reoperation rates, and 30-day mortality. Results The mean age of patients was 68.4±7.8 years. Among the 225 patients, the most common cardiac comorbidity was ischemic heart disease, seen in 142 (63.1%) patients, followed by congestive heart failure in 51 (22.7%). Intraoperative hypotension occurred in 63 (28.0%) patients, while bradycardia was observed in 27 (12.0%). Vasopressor support was required in 52 (23.1%) patients. Postoperatively, new-onset arrhythmias developed in 11 (4.9%) cases, acute heart failure in seven (3.1%) cases, non-fatal myocardial infarction in three (1.3%) cases, and TUR syndrome in five (2.2%) cases. Reoperation was necessary in four (1.8%) patients, and two (0.9%) patients died within 30 days of the procedure. Conclusion TURP under spinal anesthesia appears to be a safe and effective procedure for high-risk cardiac patients when managed with careful preoperative assessment and intraoperative monitoring. Spinal anesthesia provides a favorable balance between surgical efficacy and cardiovascular safety in this vulnerable population. Further multicenter prospective studies are recommended to confirm these findings and develop standardized perioperative care protocols.
背景 经尿道前列腺切除术（TURP）是良性前列腺增生（BPH）的标准外科治疗方法。然而，其在高危心脏病患者中的安全性仍是临床关注的问题，尤其是围手术期心脏并发症方面。目的 评估高危心脏病患者在脊髓麻醉下进行TURP的术中及术后结果。方法 这项描述性观察性研究纳入了225名年龄≥50岁且有记录的高危心脏疾病（美国麻醉医师协会（ASA）Ⅲ - Ⅳ级）的男性患者。2023年2月至2023年8月期间，所有患者均在拉合尔法蒂玛·真纳医科大学（FJMU）/冈加拉姆爵士教学医院泌尿外科接受脊髓麻醉下的TURP。收集的数据包括人口统计学变量、心脏合并症、术中血流动力学变化、术后心脏事件、TUR综合征发生率、再次手术率和30天死亡率。结果 患者的平均年龄为68.4±7.8岁。在225名患者中，最常见的心脏合并症是缺血性心脏病，有142例（63.1%），其次是充血性心力衰竭51例（22.7%）。63例（28.0%）患者术中出现低血压，27例（12.0%）观察到心动过缓。52例（23.1%）患者需要血管升压药支持。术后，11例（4.9%）出现新发心律失常，7例（3.1%）出现急性心力衰竭，3例（1.3%）出现非致命性心肌梗死，5例（2.2%）出现TUR综合征。4例（1.8%）患者需要再次手术，2例（0.9%）患者在手术后30天内死亡。结论 对于高危心脏病患者，在进行仔细的术前评估和术中监测后，脊髓麻醉下的TURP似乎是一种安全有效的手术。在这一脆弱人群中，脊髓麻醉在手术效果和心血管安全之间提供了良好的平衡。建议进一步开展多中心前瞻性研究以证实这些发现并制定标准化的围手术期护理方案。
