4. RESEARCH RECOMMENDATIONS

The evidence base for this guideline is limited. Much of the evidence regarding baseline risk is low, or very low quality [8,9]. Prospective observational studies to establish baseline risk of VTE and bleeding in a wide variety of urologic procedures, as well as addressing patient risk factors for both thrombosis and bleeding, will be necessary to create more definite guidelines. Examples of procedures in which the evidence base is particularly limited include robotic cystectomy, laparoscopic radical nephrectomy, open nephroureterectomy, TURP and prolapse surgery. To confidently establish the baseline risk of VTE and bleeding for specific surgery will require studies that meet certain methodologic standards, such as comprehensive characterisation of the patient populations and follow-up times, documentation of the prophylaxis used, and explicit criteria with demonstration of reproducibility of judgments for documentation of DVT, PE, and bleeding assessments. Furthermore, the optimal timing and duration of thromboprophylaxis remains unclear. Timing and duration questions will be best addressed by large-scale randomised trials.