Perioperative Urology
Good urological surgery is bookended by good perioperative care — optimise before, protect during, and anticipate the predictable complications after.
The big picture
Treat every operation as three phases. Before: assess fitness, optimise comorbidity, plan anticoagulation and antibiotic prophylaxis, consent. During: position safely, give thromboprophylaxis, maintain asepsis. After: monitor for the predictable complications and manage drains, catheters and stents.
Optimise before, protect during, anticipate after — and balance every anticoagulation and prophylaxis decision against its specific risk.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Deliver a structured perioperative pathway: optimise and plan before, protect during, and monitor/manage after.
Procedure chooser
- Meticulous asepsis and the operative principles of the planned procedure
Complications
- Postoperative fever (atelectasis, UTI, wound, DVT, anastomotic leak by timeline)
- Ileus
- Bleeding/clot retention
- Urine leak from an anastomosis
- DVT/PE
- Wound and catheter-associated infection
- Positioning nerve injuries
- Contrast nephropathy
- Bleeding from continued anticoagulation, or thrombosis from stopping it
- Padded positioning and DVT prophylaxis
- Correct antibiotic prophylaxis and sterile urine
- Balanced anticoagulation plan
- Early mobilisation
- Work up postoperative fever by timeline
- Treat ileus supportively (bowel rest, electrolytes)
- Irrigate/evacuate clot and secure haemostasis
- Drain and divert a urine leak; ensure adequate stenting/catheter drainage
Follow-up
- Observations, urine output, drain volumes and character
- Wound and catheter/stent status
- Return of bowel function
- Daily review; remove drains/catheters as outputs settle
- Arrange timely stent removal to avoid encrustation
- Stable observations, falling drain output, normal bowel function, planned tube removal
- Rising drain output (leak), persistent fever, bleeding, retained/encrusted stent
- Suspected leak, collection, or bleeding
- Stricture at an anastomosis
- Forgotten stent (encrustation)
Memory hooks
Before, during, after.
Postop fever causes by timeline (wind, water, walking, wound, weird drugs).
Sterile urine before instrumentation.
Track every stent to removal.
Board traps
Instrumenting a patient with a positive urine culture — treat first.
Rising drain creatinine after pelvic surgery — urine leak.
A forgotten encrusted stent presenting months later.
Stopping anticoagulation in a patient with a recent coronary stent — high thrombotic risk; bridge.
Clinical cases
Five days after a partial nephrectomy, drain output rises and its creatinine is far higher than serum; the patient is otherwise stable.
What is the diagnosis and the principle of management?