Managing Preoperative Anxiety and Thromboprophylaxis in Children Undergoing Urological Procedures: An Update of the European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology

Context: The literature on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures is still limited, resulting in a generally low level of evidence. These guidelines aim to provide a practical approach based on a consensus from the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) Paediatric Urology Guidelines Panel. Objective: The authors aim to provide the 2024 EAU/ESPU Paediatric Urology Guidelines Panel update of the chapter on perioperative management of urological procedures in children. Evidence acquisition: A structured literature review was performed for all relevant publications published from the last update until April 03, 2023. Evidence synthesis: The most important updates include the following: anxiety and distress should be prevented or relieved by combining measures such as premedication, distraction techniques, and presence of parents or caregivers. Clinicians should select the appropriate premedication depending on the patient's age, underlying conditions, and psychological status. A particular focus must be placed on paediatric patients with "special needs", including children with psychophysical disorders that impact their relational and cognitive abilities. This unique population requires carefully tailored perioperative management. The incidence of perioperative thromboembolic events in the paediatric population is generally low. Controversies still exist on whether to perform a preoperative coagulation panel test on a routine basis. Neonates and adolescents are at a higher risk of perioperative thromboembolic events than the other children. Standard perioperative antithrombotic prophylaxis is not recommended due to a lack of high-quality evidence-based data. Conclusions: This paper is a summary of evidence on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures. Patient summary: In this summary and update of the European Association of Urology/European Society for Paediatric Urology guidelines on paediatric urology, we provide practical considerations for preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.