Patients on Preoperative Medications – What urologists must know?

Dear All,

We Urologists treat many patients with comorbidities.

Many of our patients are on Anticoagulants and antiplatelets. There is considerable controversy regarding whether such medications need to be stopped or can be continued in a patient undergoing Urological Procedures. The controversy extends even for patients who need Emergency Surgery.

I am providing some literature from which one can get fairly detailed information as regards the ‘Dos and Don’ts’ concerning this controversy.

To commence with I am providing an ‘Overview of the coagulation system’.

https://www.ijaweb.org/article.asp?issn=0019-5049;year=2014;volume=58;issue=5;spage=515;epage=523;aulast=Palta  (PDF available) or

https://www.ijaweb.org/temp/IndianJAnaesth585515-1293238_033532.pdf

There are several articles addressing this issue and few of them are given below.

https://www.auanet.org/guidelines/anticoagulation-and-antiplatelet-therapy

https://bjui-journals.onlinelibrary.wiley.com/doi/pdf/10.1111/bju.13131 (Downloadable PDF available)

https://www.karger.com/Article/PDF/447214

https://journals.sagepub.com/doi/pdf/10.1177/2051415817728612

Read together should enable us to have a good idea as to the prevailing knowledge.

Diabetes is a common ailment many of our patients have and appropriate treatments with both Injectables and Oral are there in current practice.

Similarly, Patients are many Drugs aimed at relieving Urological problems when they come for the needed surgical treatments. There is not much evidence as whether these drugs can be continued or need to be stopped prior to undertaking Urological Procedures. An article from Mayo Clinic Proceedings addresses these issues. I am providing the tables accompanying the article so that we have an understanding the ‘Dos and Don’ts’.

One aspect which is important not taken up is ‘Preop, Periop and Postop management of Pheochromocytoma’. This is an important aspect that all need to know in detail though Pheo’s is not that frequent.

I am sure these informations provided will help all of us in mangling patients with several medications.

With warm Regards,

Venu

 

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