Surgery With A/F

Hi,

After attending my local hospital Urology Clinic and having a few tests and a Cystoscopy it appears that I am going to need surgery (TURP) on a Benign Enlarged Prostrate. I have Persistent/Permanent A/F and when I mentioned this at the clinic, I was informed that this would be taken into account and discussed at the pre-op. Obviously, I am concerned about it and was wondering if any members with the same have had this type of surgery.

Regards,

Mikee

31 Replies

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  • Hi. I have PAF and i too last week had a pre-op assessment where this condition was discussed. The outcome was the same as yours and it would be considered on the day but of more importance and concern was that i must stop my anti-coagulation medicines 48 hours prior to the operation. The afib was very much a minor consideration.

  • My op was a four+ hour radical prostatectomy which they would not have wanted to do if I had AF but my understanding is that what is basically a reaming procedure is relatively quick so the control period is short by comparison. I doubt anybody will say one way or the other till the day as it really depends on each individual and I think the anaesthetist who will be looking after you during the surgery. The gap in anticoagulation is just something we all have to put up with. I was off mine for about ten days until all my wound drains came out but that should apply to you.

  • Hi jonjub + Bob,

    Thanks very much for your replies, I believe one of the options is, instead of a General Anaesthetic they can use a spinal injection which numbs you from the waist down and you are awake throughout the operation. I will be asking if this is the safest route as regards to the A/F and if they think it is I will go for this.

    Thanks again,

    Mikee.

  • The spinal actually puts a bit more strain on the heart than a general anaesthetic as your blood pressure is more likely to fall, but it's easier on the lungs.

  • Thanks Goldfish, that's another question for me to ask.

  • Hi Mikee , I had a total knee replacement last November with a spinal injection,I was really nervous!! I need not have been,the theatre staff were very reassuring and calming ,I was fine and would do this again. I did not have permanent Af but Paroxysmal Af.

    good luck

  • sorry should not apply to you

  • Why not use edit function?

  • It was a couple of hours later Peter and I thought it might confuse otherwise.

  • Edit Function? How do I find that?

  • Either to the right of the like box or underneath the reply box you will see another one with an arrowhead pointing down. Select box and a number of options are displayed and you can select edit. Delete or add as required then press green box Edit Reply.

    You can only edit your own posts.

  • Thank you.

  • Hello Bob,

    After discussing the results of the tests I had at the clinic and being told about the surgery, I was given paperwork etc. to look over at home. It mentions the two options, Spinal or General Anaesthetic, stating that, with the agreement of the Surgeon the choice would be mine.

    Presumably, you mean that because of my A/F the Spinal Anaesthetic will not come into it.

  • MIkee I was talking about the length of time I was off anticoagulants due to having several drains which you should not need. I'm assuming you will have a catheter for a while post op but not the drain tubes I had.

  • I don't know if anyone else feels that the pre-op assessment system is a bit flawed? Surely there must be some general principles that the patient should be told about e.g. if your BP is too high/too low we won't do the procedure. I know someone who has cataract operations postponed because her BP was too high.

    Someone could be in NSR at a pre-op assessment then have an AF episode on the day of the operation itself. Or vice versa. I guess that a lot will depend on circumstances such as the type of operation and a weighing up of risks and benefits.

    Very difficult for people in permanent AF particularly. I feel hospitals should be a bit more transparent. Has anyone actually asked the question aboit what happens to the operation of they are in AF and got a straight answer?

  • From my experience I believe that the pre-op assessments are fundamentally flawed in far too many instances and this leads to far too many cancellations or operations / procedures that should not go ahead.

    As for methods I was told that i should never have a general anaesthetic unless there was absolutely no alternative and it was life saving. Sedation, locals, spinals were the way to proceed. However some operations/ procedures would be deemed inappropriate because of the risks. Also heart consultant said that I should always be bridged and not stop Anticoagulation for days before and wait days intil INR back up to level afterwards even though I seem to be back over 2.5 in about 3 days. He said 10 days off Anticoagulation is the high risk period for reasons they don't know about.

    I am in persistent AF.

  • So presumably you could only have an ablation under sedation? I know I should worry less about scenarios that don't currently affect me but it does bother me that I might, say, need a hip operation which could be refused.

  • This is what I dont understand Mrs Pat. We know that ablations are done under GA as well as sedation because many many people on the forum have taken that option when offered. Ablations often last 5 or 6 hours. So what is the difference in risk between an GA for an ablation and GA for lets say bowel surgery or hip replacement? Maybe because the heart rhythm expert is doing the ablation whereas another surgeon may not have their expertise if things go wrong with the rhythm?

    I hope someone knows the answer for this as it is a bit worrying for those of us who can not or will not have an ablation.

    I will ask this question at Patients day I think.

  • Certainly part of it is when having an ablation you have a cardiac team of some 8 or so people there. Also there are various types / mixes of anaesthetic depending on what's being done. I was told that the risks are much higher for a GA than sedation. Also that a GA can trigger AF.

  • A cardiologist told me that the Cath Lab is the safest place in the world to have a procedure done.

  • Do please share the answer with us. Thanks.

  • If you go to one of the larger hospitals Mrs Pat they will sort your problems out when it comes to operations. I have had two hip replacements in five years and three generally unsuccessful ablations. Despite having AF being controlled by large doses of Flecainide at the time of the first total hip replacement I had a General anaesthetic and a successful operation. At the second hip replacement just over a year ago my AF was all over the place even on very strong medication. I still had the operation but under spinal anaesthetic. It too was successful without problems. I have a severe blood clotting problem so I had to have an IVC filter put in before the operation and taken out 5 days afterwords. This isn't necessary for normally anticoagulant patients. My EP was happy for me to have the last hip replacement as he knew I was in good hands and he would be contacted if there were problems. Like you I was terrified of having an operation but was amazed at how well my care was handled - especially in maintaining my safe anticoagulation. Fear not! Anne

  • Very reassuring, thank you. Fortunately not needing anything at the moment.

  • First can ask if you have been given other options than TURP? It is the old 'Gold Standard' treatment for BPH and there are now options with much better outcomes and quicker recovery times.

    There are several laser procedures of which I have had two. (Green Light PVP in 2005 when my prostate was 75 grms and Thulium/Holmium in 2013 when it had regrown to 135grms when on Warfarin) Two other procedures are PAE done by a radiologist where radiation is used that eventually cuts of blood supply to the prostate and it shrinks. The other is UroLift where the tissue causing the obstruction is tied back away from the urethra.

    I had a GA for each procedure. The PVP took just over an hour to do. I asked about a spinal for Thulium/Holmium procedure but the surgeon said that it would take about 3 ½ hours and that a GA was preferable.

    This year NICE have made the new version of PVP named GL XPS the preferred treatment to replace TURP. GL burns all the tissue away but Thulium/Holmium and HoLep save tissue to check for cancer cells.

    nice.org.uk/news/press-and-...

    nice.org.uk/guidance/mtg26?...

    nhs.uk/Conditions/Prostate-...

  • Hi, seasider,

    thanks for your reply. At the moment there as only been mention of TURP but it's early days yet and I intend asking a lot of questions before anything is decided, I will certainly bring up some of the points that you mention.

    Thanks to everybody else for their interesting comments, like other members mention often, "this is the forum for good advice".

    Mikee.

  • I had to fight to get referred to a hospital in England from Scotland to one doing PVP as the old timer Urologists don't like new things. At that time it was still in its trial stages in the UK although had been done in the US for over a year. They said in many parts of the UK that we will never do PVP at this hospital. Most now do but there are still parts of the country in the Dark Ages.

    New procedures, new learning, new expensive equipment their attitude is why bother.

    I had the PVP done on a Friday afternoon and was supposed to leave hospital and travel home on the Saturday. However as I still had some retention after the overnight catheter was removed they did not want me to be away from help until I could void completely. I travelled home by train on the Sunday afternoon and on the Monday went to the races. No one could believe that I had had the operation on the Friday. No pain just a spurt of blood at the start of urination and a burning feeling for a few days and a rose output. Usually I would have been to the toilet several times during the afternoon but despite two mugs of coffee I had to think that I had better go before going home.

    The Thulium/Holmium procedure I had is not widely performed. Now my first choice would be PAE followed by HoLep. Actually my local hospital urologists were against laser and told me for two years that they only did TURP. It was only when seeing a locum one time who did not know their rules that he told me that Mr X had been doing Thulium for years and asked if I wanted to see him.

    I passed more blood after the Thulium/Holmium procedure and they sent me home with a catheter in. That may or may not have been due to warfarin from memory I only stopped it for three days.

  • To reduce the risks insist in bridging before and after. Unfortunately many surgeons do not know about the increased risks of clots either side of an operation.

  • I had a beast cancer operation in june 2014 I think I stopped my noac the previous day. I have permanent AF and take meds. For the days after the op I was given Heperin (or whatever it is called now ) and then went back onto the noac.

    The anestatist did say some about a lighter anesthetic and that I would be monitored very closely. I do know that when I came round (which was very quickly) I was very alert, no sickness or nausea and out of bed a couple of hours later. I did have a chest drain for a couple days but that ran clear faily quickly.

    So maybe they do use different anesthetics.

    Cassie

  • Just to add the AF behaved itself, no problems that I know of.

  • I had a hysterectomy in July under GA. The anaesthetist knew all about AF and reassured me that they had the means to deal with an episode in the theatre if my paroxysmal AF kicked off during the operation. He had also asked for a bed in the High Dependency Unit for me the first night but they didn't have one available so I was on the normal ward with more frequent checks.

    As it turns out, I was fine all the way through the operation but AF kicked in when I was back on the ward that evening and lasted overnight. I then had another shorter episode a few days later but nothing since 5th August now. I mentioned what had happened to the AF nurse and she wasn't surprised that I'd had an episode after a general anaesthetic.

    Caroline

  • Thanks to all of you who replied to my post, your input has given me more confidence regarding the surgery and also plenty of questions to ask at next appointment. Keep well.

    Regards,

    Mikee.

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