Abstract

Introduction: Pacemakers have been used to maintain the heart rate when inherent conduction system of

the heart fails, either because of disease or surgery. In urologic patients cardiac pacemaker has becoming

increased due to advanced age. They are influenced by electrocautery, ionising radiation or radiofrequency in

various degrees. Electrocautery is commonly used during surgery to achieve hemostasis. During surgical

intervention, electrocautery may cause arhythmia, and death in patients with cardiac pacemaker. In urologic

practice there have been limited number of publications about this subject and most of them are case reports.

We present herein five patients with cardiac pacemaker who underwent transurethral prostate resection and

penile prothesis implantation operations.

Materials and Methods: Between January 2000 and May 2004 a total of 5 patients with cardiac pacemaker

(4 patients with the diagnosis of benign prostatic hyperplasia and 1 patient with the diagnosis of erectile

dysfunction) were included into the study. Preoperatively all patients were evaluated with detail history,

physical examination including digital rectal examination, serum PSA (prostate specific antigene) levels,

urinary ultrasonography, routine urine, hematologic and biochemical analysis. Also, preoperatively all

patients evaluated in cardiology and anaesthesiology clinics.

Results: The mean age of the patients was 63.8 (range 52-71) years. In patients, the mean duration of the

cardiac pacemaker implantation was 2.1 (range 1.3-3) years. No surgical complications were seen during the

operation. Cardiac pacemaker was inhibited in two of 4 patients who underwent TUR-P operation by their

native rhythm. Monopolar cautery was used in these two patients. Among these patients, cardiac arhytmi

developed in a patient although pacemaker was inhibited. At this point, defibrillation and medical treatment

was performed. Complications were not observed remain three patients. At postoperative fourth hours cardiac

pacemakers were activated in all patients. Remain four patients with BPH and erectile dysfunction bipolar

cautery was used.

Conclusion: Pacemakers are becoming increasingly complex and all anaesthesits and surgeons should

have detailed knowledge of pacemaker nomeclature and the significance of the individual functions. In

particular, they should know how to manage a patient whose device fails intra-operatively. We recommend

close intraoperative monitorization of heart rate and rythm in patients with cardiac pacemaker.