Study Type – Therapy (case series)Level of Evidence 4What’s known on the subject? and What does the study add?The incidence of deep venous thrombosis (DVT) in major urological surgery has decreased over time with the introduction of pharmacological prophylaxis, early mobilization, and the use of sequential mechanical compression devices. We examined the value of heparin prophylaxis in robotic assisted laparoscopic prostatectomy (RALP), where the risk of DVT is already low.The rate of thromboemolic events within 30 days was 0.6% in this series. Heparin did not influence estimated blood loss, haematrocrit change, or length of stay. The incidence of thromboembolism is low after RALP, which may obviate the use of heparin prophylaxis. However, its use appears to be safe and does not affect surgical outcomes.OBJECTIVE• The incidence of venous thromboembolism (VTE) after robotic‐assisted laparoscopic prostatectomy (RALP) in patients receiving perioperative heparin prophylaxis was compared with those who did not receive such prophylaxis.MATERIALS AND METHODS• Between July 2007 to February 2010, a total of 307 RALPs were performed at our institution by two surgeons. A total of 187 patients operated on by surgeon 1 received perioperative heparin prophylaxis, whereas 120 patients operated on by surgeon 2 did not receive any.• All demographic, clinical and pathological data were prospectively recorded, whereas the incidence of venous thromboembolism within 30 days of the operation was retrospectively reviewed. Evaluation for potential VTE was based on clinical symptoms.RESULTS• Cohorts were comparable with respect to PSA, clinical stage, preoperative Gleason score, body mass index, smoking status, pathological stage, path Gleason score and margin status. A total of two thromboemoblic events occurred (0.6%) within 30 days of surgery (one in each arm of the study).• Heparin prophylaxis did not influence estimated blood loss (P= 0.076) or haematocrit change from preoperative levels (P= 0.378). Length of stay was comparable between the two groups (1.4 vs 1.3 days; P= 0.159).CONCLUSION• The incidence of thromboembolism is low after RALP, which may obviate the need for heparin prophylaxis. However, its use is safe and does not impact surgical outcomes. Larger series are needed to confirm the results obtained in the present study.
RESULTS: Of 26.5 million pediatric hospitalizations during the study period, 40,084 overall (150 per 100,000) were for UUTC. Crude and adjusted rates of pediatric hospital admission for UUTC decreased significantly between 2001 and 2012 (p < 0.0001 for each). Total number of all-cause hospitalizations also decreased during this period, but to a lesser degree than for UUTC. Surgical procedures were conducted in 17,646 (44.0%) of overall hospitalizations for UTUC, with significantly increasing frequency over the study interval (p<0.0001). Urinary tract drainage was the most frequently performed surgical intervention. CONCLUSIONS: In analyzing nationwide data, the rate of pediatric hospitalization for UUTC has significantly decreased between 2001 and 2012, while the rate of surgical activity during hospitalization has significantly increased. Specific factors driving these trends warrant further investigation.
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