Surgical Considerations for the Geriatric Urology Patient

INTRODUCTION: As the number of geriatric patients continues to increase, urologists will encounter more elderly patients who require counseling about medical or surgical management of their conditions. In this review we provide a practical pathway for the elderly patient being considered for urological surgery. METHODS: Our review includes preoperative evaluation and assessment for cognition, frailty, functional status, falls, cardiovascular and pulmonary status, and nutritional state. RESULTS: Intraoperative concerns include operative procedure choice (with minimally invasive approaches emphasized), positioning, hypothermia, and antibiotic and venous thromboembolism prophylaxis. Postoperative attention requires assessment for delirium, early ambulation, fall prevention, lung expansion, avoidance of nasogastric tubes, early oral feeding and adequate but age adjusted pain control. Appropriate discharge from the hospital must follow, with planning started in the preoperative phase. CONCLUSIONS: Special attention to these adjustments in the operative pathway lead to high operative success rates with a lower risk of complications.