Pulmonary Emboli

In urologic malignancies the primary respiratory complication is fatal postoperative pulmonary emboli (PE) (Fig. 13.7). The incidence of deep venous thrombosis (DVT) and PE following urologic surgery in patients without prophylaxis has been reported to be as high as 50% and 22%, respectively (Allgood et al. 1970; Mayo et al. 1971). With the use of intermittent pneumatic compression devices, the incidence of PE has decrease to 2% (Igel et al. 1987; Leandri et al. 1992; Lepor and Kaci 2003; Soderdahl et al. 1997). Scardino and others at Baylor College of Medicine published an extensive

Fig. 13.7. Pulmonary embolism. Contrast-enhanced CT demonstrating pulmonary embolism as large filling defect within proximal right pulmonary artery in patient with renal cell carcinoma

review of published series reporting the perioperative morbidity of radical prostatectomy (Dillioglugil et al. 1997). In a combined series of nearly 1,300 patients, the mortality rate was 1.18 %, with a PE incidence of 2.76 %.

Controversy exists regarding the optimal DVT prophylaxis for GU patients. The University College of Dublin forwarded questionnaires to all urology residency programs in Ireland, the United Kingdom, and the United States regarding the current practice with respect to thromboprophylaxis (Galvin et al. 2004). Among the three countries, there was no difference in the use of nonpharmacological thromboprophylaxis, with about 75 % using either intermittent pneumatic compression devices or support stockings. However; just 24% of American urologists use pharmacological thromboprophylaxis, such as conventional or low-molecular-weight heparin, in contrast to 100% of British urologists.

There continues to be no consensus in regards to the optimal DVT prophylaxis, though the minimum would be the use of support stockings with either the addition of compression devices or pharmacological thrombo-prophylaxis.

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