[ASA and clopidogrel for urological operations. Perioperative management]

[Superficial bladder cancer: Transurethral resection and instillation therapy]

Bladder cancer is the fifth most common tumor in men with the incidence of bladder tumors continuing to rise in industrialized and developed countries. Because 80% of all bladder tumors grow on the surface, endoscopic transurethral resection (TUR-B) can be used for complete removal. Due to continuous technical developments and improvements of endoscopic equipment, video imaging and bipolar resection (TUR-IS) offers a high level of safety. Despite optimal equipment, intra- and postoperative complications in transurethral electrosurgery of bladder tumors may occur.

[Transurethral resection of bladder tumors: management of complications]

As a frequent endourological procedure, transurethral resection of bladder tumors (TURB) represents a major field of activity for urological surgeons. Although TURB represents an endoscopic training procedure for urology residents, there are clear requirements for the quality of the surgical procedure as such. The knowledge of possible complications and their management are essential for urologists active in the clinical field. Bleeding complications, bladder perforation, infections and injuries to the ureteral orifice are the most frequently observed complications. This article summarizes the essential risks and complications as well as the corresponding preventive and therapeutic measures.

[Rivaroxaban, dabigatran and apixaban: new anticoagulants in operative urology]

The periprocedural management of patients receiving long-term oral anticoagulant therapy is a common but complex clinical problem. It is well established that maintaining oral anticoagulation is associated with an increased risk of bleeding in the periprocedural period while discontinuing anticoagulant therapy postoperatively leads to an elevated risk for thromboembolic events, especially in high risk patients. Nowadays there is growing evidence to maintain antiplatelet therapy with acetylsalicylic acid (ASS, Aspirin®) perioperatively in a setting of secondary prophylaxis. Beyond that the increasing routine clinical use of novel oral anticoagulants (NOACs), such as the direct factor IIa inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban and apixaban, presents a challenge for urological surgeons. These agents are approved in patients with nonvalvular atrial fibrillation (rivaroxaban, dabigatran and apixaban) and in patients after deep vein thrombosis and pulmonary embolism (rivaroxaban). Due to their relatively short elimination half-lives and rapid onset of action, these new drugs have the potential to simplify periprocedural anticoagulant management making heparin bridging therapy redundant. Critical consideration is necessary regarding potential pitfalls, such as impaired renal function, insufficient possibility of laboratory monitoring and lack of antidotes in cases of postoperative hemorrhage. Although periprocedural protocols for the use of NOACs are emerging, robust clinical data are still scarce. This article provides a practical, clinician-focused approach to periprocedural management of NOACs.