Editing CUA: VTE Prophylaxis (2019) (section)

== Recommendations for use of VTE prophylaxis in urological surgery ==

* '''See Table from Original Guideline for''' '''summary of CUA recommendations for postoperative VTE prophylaxis'''
* '''The following recommendations apply to the use of LMWH as a prophylactic agent, starting the morning after surgery and CONTINUING FOR 28 DAYS as compared to not giving any pharmacological prophylaxis.'''
* '''Risk factors for VTE (4):'''
*# '''Age > 75''' (2x risk)
*# '''BMI ≥35'''(2x risk)
*# '''VTE in 1st degree relative''' (parents, full siblings, or children) (2x risk)
*# '''Personal history of VTE''' (4x risk)
* '''Risk stratification'''
** '''Low-risk: no risk factors'''
** '''Moderate-risk: any 1 risk factor (other than personal history of VTE (high-risk))'''
** '''High-risk: ≥2 risk factors or personal history of VTE'''
* '''Summary of patients recommended to receive VTE prophylaxis (guidelines specify “recommend” over “suggest”)'''
** '''Oncologic surgery'''
*** '''All patients and procedures: suggest use of mechanical prophylaxis'''
*** '''Summary of pharmacologic prophylaxis recommendations:'''
**** '''Radical cystectomy: all patients'''
**** '''Radical prostatectomy'''
***** '''Open'''
****** '''All patients except low-risk undergoing RP without extended lymph node dissection'''
***** '''Laparoscopic/Robotic'''
****** '''High-risk with extended lymph node dissection'''
**** '''Nephrectomy'''
***** '''Laparoscopic/robotic'''
****** '''High-risk with partial nephrectomy'''
** '''Non-oncologic surgery'''
*** '''None'''; though high-risk patients undergoing donor nephrectomy, nephrectomy for benign disease, or renal transplant are suggested to receive pharmacological and mechanical prophylaxis

* '''Detailed recommended for VTE prophylaxis'''
** Oncologic surgery
*** Bladder (radical cystectomy (open or robotic))
**** All patients: recommend pharmacological prophylaxis
*** Prostate (radical prostatectomy)
**** Stratified based on approach (open vs. lap/robotic) and extent of lymph node dissection
***** No lymph node dissection
***** Standard dissection (node of Cloquet, along external iliac vein to the bifurcation of the internal and external iliac, and obturator fossa)
***** Extended dissection (standard dissection and dissection above bifurcations of iliac vessels or including presacral, precaval, or preaortic nodes)
**** Open radical prostatectomy
***** Without extended lymph node dissection:
****** Low-risk: suggest pharmacological prophylaxis
****** Moderate or high-risk: recommend pharmacological prophylaxis
***** With extended lymph node dissection:
****** All patients: recommend pharmacological prophylaxis
**** Robotic or laparoscopic radical prostatectomy
***** Without lymph node dissection:
****** Low-risk: recommend against use of pharmacological prophylaxis
****** Moderate or high-risk: suggest against use of pharmacological prophylaxis
***** With standard lymph node dissection
****** Low-risk: recommend against use of pharmacological prophylaxis
****** Moderate-risk: suggest against use of pharmacological prophylaxis
****** High-risk: suggest use of pharmacological prophylaxis
***** With extended lymph node dissection
****** Low-risk: suggest against use of pharmacological prophylaxis
****** Moderate-risk: suggest use of pharmacological prophylaxis
****** High-risk: recommend use of pharmacological prophylaxis
*** Kidney
**** Open (RN, PN, nephroureterectomy)
***** All patients: suggest use of pharmacological prophylaxis
**** Laparoscopic renal surgery for cancer
***** Radical nephrectomy or laparoscopic nephroureterectomy
****** Low or moderate-risk: suggest against use of pharmacological prophylaxis
****** High-risk: suggest use of pharmacological prophylaxis
***** Partial nephrectomy
****** Low or moderate-risk: suggest against use of pharmacological prophylaxis
****** High-risk: recommend use of pharmacological prophylaxis
***** Robotic renal surgery
****** Partial nephrectomy
******* Low-risk: suggest against use of pharmacological prophylaxis
******* Moderate-risk: suggest use of pharmacological prophylaxis
******* High-risk: recommend use of pharmacological prophylaxis
*** RPLND (primary or post-chemotherapy)
**** All patients: suggest pharmacological prophylaxis
** Non-oncological surgery
*** Ambulatory day surgery, TURP, continence, or prolapse surgery
**** All patients: recommend against pharmacological prophylaxis and suggest against use of mechanical prophylaxis
*** TURP, continence or prolapse surgery
**** All patients: suggest against use of pharmacological use and suggest against use of mechanical prophylaxis
*** Donor nephrectomy, nephrectomy for benign disease, renal transplant
**** Low or moderate-risk: suggest against use of pharmacological prophylaxis and suggest against
**** High-risk: suggest use of pharmacological and mechanical prophylaxis