The number of patients on chronic
anticoagulant or antiplatelet
therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the perioperative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of
bleeding versus
thrombosis, and the important possible clinical and medical legal repercussions therein. Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge. The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high-risk group of patients, focusing on the perioperative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate,
Thulium,
Holmium and greenlight
laser prostatectomy),
bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial
cancer, and
nephrolithiasis. Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of
acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/high risk of
coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight
heparin can potentially lead to more
bleeding than continuation of the
anticoagulant(s) and antiplatelet
therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team.