Prostate Surgery Options for Patients with Poor Lung Function

Q: Prostate Surgery Options for Patients with Poor Lung Function

Hello： Currently, only a few hospitals perform prostate artery embolization. <br>Laser treatment still requires anesthesia, which carries less risk than traditional surgery, but it is not without risks. <br>Older individuals often have compromised systems and may experience slowe

Patients with poor cardiopulmonary function who require prostate surgery?

Hello, Director.
My father is about 90 years old and has severe chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH).
He has been using a urinary bag for nearly five months, with repeated insertions and removals.
Recently, he experienced his second episode of hematuria.
The attending physician initially planned to remove the stones and also perform a prostatectomy, but the surgery was canceled due to my father's blood oxygen levels being only around 90, making anesthesia unfeasible.

I found that there are non-anesthetic options such as GreenLight laser therapy and prostatic artery embolization.
I understand that GreenLight laser therapy is out-of-pocket, but I am unsure if prostatic artery embolization is also an out-of-pocket expense.
My father is alert but has been bedridden for a long time, making him prone to dyspnea.
He also has hypertension and chronic constipation.

Could you please recommend which procedure you would prefer, considering factors such as intraoperative pain, surgical risks, recurrence rates, postoperative care, recovery time, or any other professional insights? We will discuss this with the attending physician, but it seems that neither procedure can be performed at the hospital we are visiting, so I apologize for the trouble and appreciate your assistance.
Thank you very much.

Niming, 30~39 year old female. Ask Date: 2019/04/28

Dr. Du Shixi reply Urology

Hello: Currently, only a few hospitals perform prostate artery embolization.
Laser treatment still requires anesthesia, which carries less risk than traditional surgery, but it is not without risks.
Older individuals often have compromised systems and may experience slower recovery from certain surgeries.
Postoperative complications can occur, so if there is a need to address the issue, one must be mentally prepared.
Conditions such as asthma, hypertension, and habitual constipation are common concerns related to anesthesia and surgery.
Wishing you good health.

Reply Date: 2019/04/28

More Info

When considering prostate surgery options for elderly patients with significant comorbidities such as chronic obstructive pulmonary disease (COPD), it is crucial to weigh the risks and benefits of each procedure carefully. Your father's situation, given his age and health status, requires a thoughtful approach to ensure his safety and comfort.

Surgical Options
1. GreenLight Laser Therapy: This minimally invasive procedure uses laser technology to remove excess prostate tissue. It is often performed under general anesthesia, but some centers may offer it with sedation or local anesthesia. The advantages include reduced bleeding, shorter recovery time, and less postoperative pain compared to traditional surgery. However, it may not be suitable for all patients, especially those with severe lung issues, as anesthesia can still pose risks.

2. Prostate Artery Embolization (PAE): This is a newer, less invasive procedure that involves blocking the blood supply to the prostate, causing it to shrink. PAE is performed under local anesthesia and sedation, which may be beneficial for patients with poor lung function. It typically has a shorter recovery time and less postoperative discomfort. However, availability may be limited, and it is essential to confirm whether your local hospital offers this procedure.

3. Transurethral Resection of the Prostate (TURP): This traditional surgical method involves removing prostate tissue through the urethra. While effective, it usually requires general or spinal anesthesia, which may not be advisable for your father due to his respiratory issues.

Considerations for Surgery
- Anesthesia Risks: Given your father's low oxygen saturation levels (around 90%), any procedure requiring general anesthesia poses a significant risk. Anesthesia can exacerbate respiratory issues, leading to complications such as pneumonia or respiratory failure.

- Postoperative Care: After any surgical procedure, especially in elderly patients, the risk of complications increases. This includes the potential for urinary retention, infection, and the need for additional interventions. Your father's long-term immobility and existing health conditions may complicate recovery.

- Quality of Life: It is essential to consider your father's quality of life post-surgery. If the surgery does not significantly improve his symptoms or if he faces a long recovery, it may not be worth the risk.

Recommendations
Given your father's health status and the risks associated with anesthesia, I would recommend discussing the following with his healthcare team:
1. Evaluate Non-Surgical Options: Before proceeding with surgery, consider discussing medication management or other non-invasive treatments that could alleviate his symptoms without the need for surgery.

2. Consult a Specialist: If possible, seek a second opinion from a urologist who specializes in treating patients with significant comorbidities. They may offer insights into the best approach tailored to your father's specific needs.

3. Discuss Risks and Benefits: Have an open conversation with his medical team about the potential risks and benefits of each surgical option, considering his lung function and overall health.

4. Consider Palliative Care: If surgery is deemed too risky, palliative care may provide symptom relief and improve his quality of life without invasive procedures.

In conclusion, while there are several surgical options available for treating prostate enlargement, the best choice for your father will depend on a comprehensive assessment of his health, the risks associated with anesthesia, and his overall treatment goals. It is essential to have thorough discussions with his healthcare providers to make an informed decision that prioritizes his safety and comfort.

Similar Q&A

Alternative Treatments for Prostatitis: Beyond Surgery Options

Hello Dr. Pan: My father is 73 years old. Two weeks ago, after taking medication for a cold, he was unable to urinate. He went to the hospital and had a catheter inserted, which has not yet been removed. The doctor diagnosed him with prostatitis and noted that his prostate is enl...

Dr. Pan Zhenqin reply Urology
Judy: Acute prostatitis can lead to acute enlargement of the prostate. Additionally, taking cold medications, especially antihistamines for runny nose, can inhibit the contraction of the bladder detrusor muscle, causing patients with benign prostatic hyperplasia who were still ab...

Exploring Alternative Treatments for Chronic Breathing Issues After Smoking

My father smoked for 30 years and although he has quit, he has been experiencing shortness of breath for the past two years when walking 200 meters, going up and down stairs, taking a shower, and especially at night when he needs to get up to urinate. He requires a bronchodilator...

Dr. Yang Wenda reply Pulmonology
Hello Vera: Your father has a long history of smoking, which may have led to chronic obstructive pulmonary disease (COPD), specifically chronic bronchitis and emphysema, resulting in significant lung function impairment. In addition to medication, Chang Gung Memorial Hospital off...

Surgical Options for Dementia Patients with Prostate Issues: A Family's Dilemma

My grandfather is 74 years old and has dementia (he does not exhibit violent tendencies but has difficulty with verbal expression). He recently underwent hernia surgery and currently has benign prostatic hyperplasia, for which he has a urinary catheter in place. He has been expre...

Dr. Tu Xiuhong reply Urology
Difficulties in urination and urinary retention are not necessarily caused by benign prostatic hyperplasia; elderly individuals may experience urination difficulties due to brain lesions as well. It is advisable to seek examination at a major hospital. Dr. Tu Hsiu-Hung.

Managing Urinary Difficulties: Insights on Prostate Health and Treatment Options

At the beginning of the year, I experienced difficulty urinating and underwent catheterization. After about five months of medication, I again faced urinary difficulties, leading to catheterization and a prostatectomy. My preoperative PSA level was 18.9, and postoperatively it dr...

Dr. Du Shixi reply Urology
Hello: Prostate cancer is quite unique; some cases may progress rapidly while others remain stable for many years. There are various treatment options available if one chooses to pursue aggressive treatment, and the complications associated with these treatments can vary. Therefo...