A 71-year-old man with a large bladder diverticulum and muscle-invasive high-grade urothelial carcinoma of the bladder has undergone neoadjuvant cisplatin-based chemotherapy and is brought into the operating room for radical cystoprostatectomy and ileal conduit urinary diversion.
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AUA Best Practice Guidelines1 recommend routine venous thromboembolic prophylaxis for patients undergoing radical cystectomy. However, in a recent survey, AUA member respondents revealed that over 30% do not routinely use VTE prophylaxis in their practice for patients undergoing RC.2
Answer: Subcutaneous heparin injection should be given upon induction of anesthesia.
This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
- Sterious S, Simhan J, Uzzo RG, Gershman B, Li T, Devarajan K, Canter D, Walton J, Fogg R, Ginzburg S, Corcoran A, Smaldone MC, Kutikov A. Familiarity and Self-Reported Compliance with American Urological Association (AUA) Best Practice Recommendations for Use of Thromboembolic Prophylaxis Amongst American Urological Association Members. Journal of Urology, 2013, Epub ahead of print.