In the past 10 -30 years, few studies have readdressed this issue, yet modern surgical techniques may have altered its prevalence. In European Urology, Dr. Scarpa and associates report on the RISTOS study, which tabulated the prevalence and outcomes of VTE in patients undergoing general surgery, gynecological and urological procedures.

Data in the RISTOS study was collected at 31 Italian hospitals, including 8 urology departments. Curative, palliative, endoscopic and nonendoscopic surgical procedures were included. Information on surgical procedures, thromboprophylaxis (at surgeons' discretion), adjuvant postoperative cancer treatments, VTE events and bleeding were recorded up to 30 days post-operatively or more if the patient was hospitalized longer.

The study included 2,372 patients; 685 (29%) had urological surgeries, 1238 (49%) had general surgery, and 450 (19%) had gynecologic surgeries. In the urology group, 85% were men and the mean age was 67.6 years. Five patients reported a history of previous VTE and 7 patients had received preoperative chemotherapy or radiotherapy. In the urology group, 61% had endoscopic procedures (55% had TURBT) as compared to 2.6% of general surgery and 12% of gynecologic patients. Furthermore, urological patients had anesthesia times shorter than 2 hours in 53% compared to 8% in general surgery and 21% in gynecologic patients. Hospital stay was also significantly shorter in urological surgeries

Thromboprophylaxis was given to 72% of urology patients, which was about 10-15% less than the other groups. Pharmacological prophylaxis with low-molecular weight heparin was used in 465 cases, unfractionated heparin in 18 cases, and compression stockings were used with pharmacological prophylaxis in 35 cases.

Six VTE events (0.87%) including 3 deaths were reported in the urology patients, although no autopsies were obtained to confirm this. This was much lower that the 2.8% in general surgery patients and 2.0% in gynecologic patients. Multivariate analysis found age>60 years, history of previous VTE, anesthesia greater than 2 hours, advanced tumors and postoperative bed rest >4 days as potential risk factors. Postoperative bleeding occurred in13.7%. This was more common in patients not receiving VTE prophylaxis (17.1%) than in patients receiving VTE prophylaxis (5.7%). Multivariate analysis found risk factors for bleeding to be duration of surgery >45 minutes, thromboprophylaxis and endoscopic surgery. It is difficult to conclude that the prevalence of VTE is less in the urological population, as the number of patients undergoing endoscopic and shorter procedures was so much greater than general surgery or gynecologic procedures. VTE remains a significant complication of Urologic procedures.

Eur Urol, July 2006

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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