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Perioperative Care

Comprehensive perioperative management for genitourinary reconstructive surgery is organized around the surgical timeline and the crosscutting protocols that span it.

Preoperative Assessment​

  • Risk CalculatorsACS NSQIP, RCRI, Apfel score, frailty indices, and GU-relevant surgical risk tools
  • Cardiovascular RiskStepwise cardiac evaluation before non-cardiac surgery (2024 AHA/ACC), functional capacity and testing, medical therapy, stents, CIEDs, and myocardial injury after surgery
  • FrailtyFrailty assessment tools, prehabilitation, and surgical risk in the frail patient
  • DiabetesPreoperative HbA1c targets, perioperative glucose targets, insulin and non-insulin drug adjustments (including SGLT2 inhibitors and GLP-1 agonists), pumps, and GU-reconstruction considerations
  • SteroidsIdentifying adrenal-insufficiency risk, testing for recovery, stress-dose coverage by anesthesia and stress level, and suspected adrenal crisis
  • ImmunosuppressionPerioperative management of transplant patients, biologics, and chronic immunosuppressive therapy

Intraoperative Care​

  • AnesthesiaGeneral, regional, MAC, and local anesthesia; airway management; neuromuscular blockade; malignant hyperthermia; depth monitoring
  • AnalgesiaMultimodal pain management, opioid-sparing strategies, regional anesthesia adjuncts
  • Nerve BlocksRegional nerve block techniques applicable to GU and pelvic reconstructive surgery
  • Nausea & VomitingPONV risk stratification, prophylaxis protocols, and rescue antiemetic therapy
  • Positioning & Nerve InjuryLithotomy, steep Trendelenburg, lateral, prone, Galdakao-Valdivia — position-specific nerve, compartment, and pressure risks
  • Draping & Skin AntisepsisSkin and vaginal antisepsis, incise drapes, hair removal, fire prevention and draping for combined abdominal-perineal cases.
  • Surgical Scrub & Hand AntisepsisWater-based scrub and waterless alcohol-based hand rub, product-specific times and volumes, and the evidence by outcome
  • Surgical GlovingGlove materials, donning technique, double gloving, perforation risk, when to change gloves and latex allergy.

Postoperative Management​

  • ConstipationOpioid-induced constipation, bowel regimens, and return of bowel function after pelvic surgery
  • Electrolyte AbnormalitiesPerioperative disturbances of sodium, potassium, calcium, magnesium and phosphate; refeeding syndrome; and bowel-exposed-to-urine metabolic problems
  • Pulmonary EmbolismDiagnosis, severity and disposition, anticoagulation and duration, reperfusion, and management in the postoperative patient
  • NutritionScreening, preoperative optimization, immunonutrition, enteral-versus-parenteral hierarchy, peripheral versus central PN and PN prescription, refeeding syndrome, GLP-1/GIP medicines, and GU-specific nutrition considerations

Perioperative Protocols​

Crosscutting pathways that span the pre-, intra-, and postoperative phases.