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 .
Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients.
PURPOSE Orthotopic neobladder reconstruction is the preferred method of urinary diversion after radical cystoprostatectomy . We evaluated urinary functional outcomes in male patients after orthotopic neobladder  using a patient question naire . MATERIAL S AND METHODS Between 2002 and 2009 patients with bladder cancer were enrolled in a clinical trial , r and omly assigned to undergo T pouch or Studer pouch diversion  after radical cystoprostatectomy . Male patients were mailed a question naire 12 or more months after surgery including items on urinary function , intermittent catheterization , number/size/wetness of pads and mucus leakage . RESULTS The question naire response rate was 68 % . Mean followup was 4.5 years ( range 1 to 8) . Only 22.3 % of patients did not use pads . In the daytime 47 % of patients used at least 1 pad , 32.2 % used small/mini pads and 22.6 % used diapers . At night 72 % used pads , 14.7 % used small/mini pads and 38.9 % used diapers . During the day and night 47 % said their pads were dry/barely wet . Overall 62.5 % of patients reported mucus leakage . Only 9.5 % of patients performed  clean intermittent self-catheterization  , of whom 70.6 % started clean intermittent self-catheterization within the first year after surgery . Increasing age and diabetes mellitus were predictors of urinary function ( p = 0.005 and 0.03 , respectively ) but did not affect pad use . CONCLUSIONS Ileal orthotopic neobladder offers good functional results but most patients wear at least 1 pad and many require diapers at night . Increasing age and diabetes mellitus predict worse urinary function but are not associated with pad use . Emptying failure is uncommon and occurs early in the postoperative period . Pad size/wetness and mucus leakage should be considered when evaluating urinary incontinence
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 .