Abstract

Introduction: Cardiac problems due to peri- and postoperative myocardial ischemia are key factors in

overall morbidity and mortality after surgery. We aimed to investigate peri- and postoperative myocardial

ischemia, myocardial damage and myocardial infarction after transurethral prostatectomy, and to determine

the risk factors for these conditions in this patient group.

Materials and Methods: The study included 40 consecutive patients (mean age, 66.7 years; age range, 49-82

years) who underwent elective transurethral prostatectomy. For each case, concomitant diseases, smoking

history, type of anesthesia for the surgery, duration of resection, and requirement for blood transfusion were

recorded. Blood samples were obtained before surgery and 12 hours, 1 day, 2 days after the operation. At each

time point, cardiac troponin-I (cTnI) and creatine kinase isoenzyme MB (CK-MB) levels were measured, and

12-lead ECG was performed. Cardiac troponin-I levels >0.4 ng/mL were considered to indicate myocardial

damage, and levels >2.0 ng/mL were taken to signal myocardial infarction. If elevated serum cTnI and/or CKMB

were detected postoperatively and the level remained high for at least 2 days, this was considered an

abnormal finding. Any new abnormal findings detected on ECG post-surgery were recorded. All results were

evaluated by the same cardiologist who was blinded to patients’ clinical conditions. Results of the patients with

and without myocardial ischemia or damage were compared statistically. Statistical analysis was performed

using logistic regression analysis.

Results: Four patients (10%) had coronary artery disease, 11 (27.5%) had hypertension, 6 (15%) had type

2 diabetes, and 9 (22.5%) had a history of smoking. General anesthesia was used in 5 (12.5%) cases, and spinal

anesthesia was used in the other 35 (87.5%) cases. The mean resection time was 59±19 minutes. Two patients

(5%) required one unit of blood each after the operation. Postoperative testing revealed elevated creatine

kinase isoenzyme MB in 18 patients (45%), and cardiac troponin-I levels >0.4 ng/mL (range, 0.5-1.1 ng/mL)

indicating myocardial damage in 5 patients (12.5%). None of the patients had cardiac troponin-I > 2.0 ng/mL

(indicating myocardial infarction) post-surgery. Postoperative ECG findings revealed no acute ischemia in any

of the men, and none of the patients showed clinical signs of myocardial ischemia. Postoperative cardiac

troponin-I and creatine kinase isoenzyme MB levels were not significantly influenced by age, type of

anesthesia, resection time, presence of preoperative coronary artery disease, presence of risk factors for

cardiac disease, or need for blood transfusion.

Conclusion: Elevated cardiac troponin I levels were determined in the 12.5% of the patients who

underwent transurethral prostatectomy. Although cTnI seems to be promising parameter to assess myocardial

damage after TURP, we believe that studies including larger series and longer follow-up of the patients with

elevated cTnI levels will show if these elevations have clinical relevance.