Postoperative Clinical Outcomes of Transurethral Resection of the Prostate (TURP) Combined With Otis Urethrotomy in High-Risk Patients With Coronary Artery Disease (Post-Angioplasty): Insights From a Prospective Observational Cohort

Background Transurethral resection of the prostate (TURP) is widely used for treating benign prostatic hyperplasia (BPH) but is associated with postoperative urethral strictures, especially in patients with narrow urethral anatomy. The risk is further complicated in patients with coronary artery disease (CAD) on dual antiplatelet therapy, where surgical bleeding and cardiac events are significant concerns. Otis urethrotomy may help reduce stricture risk, but its safety and effectiveness in high-risk cardiac patients undergoing TURP remain underexplored. Materials and methods In this prospective observational study, 80 male CAD patients with prior angioplasty underwent TURP with prophylactic Otis urethrotomy. All patients were assessed and optimized preoperatively through a multidisciplinary approach. Follow-up evaluations at one, three, and six months included assessments of urinary flow (Qmax), post-void residual (PVR) urine, International Prostatic Symptom Score (IPSS), quality of life (QOL) score, and perioperative complications. Results Urethral stricture occurred in only two patients (2.5%), notably lower than typical post-TURP rates. Qmax improved from 7.1 to 12.3 mL/s, and PVR declined from 165.5 to 52.7 mL. IPSS decreased from 23.5 to 14.3, and QOL scores improved from 4.5 to 2.0. Cardiac complications were limited to minor events (angina 2.5%, arrhythmia 1.2%), with no reinfarctions. Urological complications were mild and self-limiting. Conclusion The combination of Otis urethrotomy with TURP in CAD patients is safe and effective, yielding strong functional outcomes and low complication rates. It offers a promising surgical option in high-risk individuals when managed through a structured, multidisciplinary framework.