Expert: JM Starkman, MD - 2/5/2012

Question
I am a 65 yr old male currently on dialysis (since June '11) and in the process of getting listed for a transplant @ Hopkins.

 Because red blood cells were found thru pathology with a routine urinalysis in late Nov., the Transplant Team referred me to a Urologist. An approx 2 cm lesion, probably malignant, was discovered 1/24/12 in my bladder after a cystasgopy @ Hopkins.  It has been recommended that I have a TURBT as soon as possible.  

In addition, last Nov 2011, after wearing a halter for 6 days, it was discovered that I have a Non-Sustained Ventricular Tach (NSVT) issue.  (I have had pvc's most of my life.)  I was scheduled for an EP test this week, but I think I should deal with the bladder issue first because of the mischevious nature of cancer.

I have been able to get the TURBT scheduled here in the DC area for this week---3 weeks earlier than @ Hopkins.

The Question:  Would a spinal for the TURBT be a lower risk to my heart ?  Or is there some other solution to this ostensible conundrum ?

Answer
The risks with a spinal vs general are about the same.  A bigger question is the nature of your ventricular arrythmia.  If the arrythmia is significant enough to warrant an EP study and possible ablation then you should have your heart issue addressed first, then proceed with the bladder issue.  The issue comes up quite often and your anesthesiologist will know how to address this----but it cannot be ten minutes before the planned bladder surgery!  Arrange to have both the anesthesiologist and cardiologist determine if the arrythmia is significant enough to warrant postponing the bladder procedure to study your NSVT first.  One would not want to be on the operating room table for a bladder treatment only to go into V-tach and possibly lead to a heart attack, MI, stroke, etc!  Heart first!