Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Bowel preparation versus no preparation before ileal urinary diversion.
OBJECTIVES To compare the outcome and complications of  urinary diversion  using ileum , with and without bowel preparation . Recent studies have question ed the necessity of bowel preparation , especially for urinary diversion when ileum is used . METHODS In this clinical trial , 30 c and i date s for urinary diversion underwent a 3-day st and ard bowel preparation ( group 1 ) , and 32 were admitted 24 hours before surgery and received only a soft diet , with no oral intake , 8 hours before surgery ( group 2 ) . They were followed up for at least 6 months and were evaluated for outcome and surgical complications . RESULTS All surgical operations were performed successfully using ileum .  Postoperative complications were documented in 2 and 4 patients in groups 1 and 2 , respectively ( relative risk 0.69 , 95 % confidence interval 0.37 to 1.31 , P = 0.41 ) . Anastomotic leak , enterocutaneous fistula , and wound infection and dehiscence occurred in 1 patient in group 1 , leading to reoperation . One case of ileus was also seen in group 1 . In group 2 , wound infection and dehiscence occurred 2 in patients and ileus in 2 others . CONCLUSIONS This study failed to demonstrate any advantage of bowel preparation for urinary diversion when we use the ileal segment . Furthermore , a meticulous use of ileum can be done without the need for a colon segment in bladder substitution procedures
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .