Use of monopolar electrocautry in transurethral resection of prostate [TURP] in the presence of permanent cardiac pacemaker

A 75 years old man having a permanent pacemaker [PPM] presented to the Department of Urology Allied Hospital Faisalabad, with severe lower urinary tract symptoms. On history he had strangury, burning micturition, dysuria and hematuria. His International Prostate Symptom Score [IPSS] was severe [29 out of 35]. On Digital Rectal Examination [DRE] there was a moderately enlarged prostate with firm consistency. On ultrasonography prostate size was about 40gm. Transurethral resection of prostate [TURP] was planned. Due to PPM it was hazardous to use monopolar electrocautery in TURP. Indifferent electrode plate of diathermy was placed under the gluteal region bypassing the chest [heart and pacemaker] to remain the circuit in limited area. During surgery no fluctuation in blood pressure and no any extra ECG changes were found on cardiac monitor. Peroperative procedure and postoperative recovery was uneventful