What is the best prophylactic approach for a 59-year-old non-smoker male with a Body Mass Index (BMI) of 22 undergoing Transurethral Resection of the Prostate (TURP)?

Prophylactic Approach for a 59-Year-Old Non-Smoker Male with BMI 22 Undergoing TURP

For a 59-year-old non-smoker male with BMI 22 undergoing TURP, early ambulation alone is the most appropriate prophylactic approach as this patient falls into the low-risk category for thromboembolic events. 1, 2

Risk Assessment

• TURP is generally considered a low-risk procedure for deep vein thrombosis (DVT) with incidence rates of symptomatic venous thromboembolism (VTE) within 91 days of only 0.3-0.5% 2
• This 59-year-old patient has no significant risk factors for DVT/VTE:
  • Age <60 years (moderate risk begins at 40-60 years with additional risk factors) 1
  • Non-smoker status 1
  • Normal BMI of 22 (not obese) 1
  • No mentioned history of prior VTE, cancer, or hypercoagulable state 1, 2

Recommended Prophylactic Approach

• Early ambulation is the recommended DVT prophylaxis for low-risk patients undergoing transurethral procedures 1, 2
• No pharmacologic prophylaxis is indicated for this patient as:
  • The procedure is considered minor with relatively short operating time 1
  • The patient has no additional risk factors that would elevate him to moderate or high risk 1, 2
  • Pharmacologic prophylaxis during TURP may increase bleeding risk unnecessarily 2

Additional Considerations

Antibiotic Prophylaxis

• Perioperative antibiotic prophylaxis should be administered according to European Association of Urology (EAU) guidelines, which recommend prophylaxis only for patients at high risk of postoperative sepsis 1
• Adherence to EAU guidelines on prophylactic antibiotics has been shown to reduce antibiotic usage without increasing postoperative infection rates 1

Bleeding Management

• TURP and other transurethral procedures are not associated with high risk of postoperative bleeding according to recent studies 3
• If bleeding is a concern, bipolar TURP has shown lower transfusion rates compared to monopolar TURP 4
• Tranexamic acid may be considered if there are concerns about perioperative blood loss, as it has been shown to be effective at preventing blood loss during TURP 5

Risk Stratification Algorithm

1. Assess patient-specific risk factors:

   • Age: <40 years (low risk), 40-60 years with no additional factors (moderate risk), >60 years (high risk) 1
   • Additional factors: prior VTE, cancer, immobility, obesity, hypercoagulable states 1, 2

2. Determine appropriate prophylaxis based on risk level:

   • Low risk (this patient): Early ambulation only 1, 2
   • Moderate risk: Early ambulation plus mechanical prophylaxis (GCS or IPC) 2
   • High risk: Mechanical prophylaxis with consideration of pharmacologic prophylaxis 1, 2

Common Pitfalls to Avoid

• Overuse of pharmacologic prophylaxis in low-risk TURP patients may increase bleeding risk unnecessarily 2
• Failure to recognize patient-specific risk factors may elevate a seemingly low-risk procedure to moderate or high risk 2
• Limited data suggest greater blood loss and higher transfusion rates with LDUH in TURP patients, so mechanical prophylaxis should be preferred over pharmacologic methods for patients at high risk for bleeding 2