Outcomes of Transurethral Resection of the Prostate (TURP) in High-Risk Cardiac Patients Under Spinal Anesthesia

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.