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 .
Elimination of preoperative mechanical bowel preparation in patients undergoing cystectomy and urinary diversion.
INTRODUCTION The utility of a preoperative mechanical bowel preparation prior to bowel surgery has recently been question ed . The purpose of this study is to compare the perioperative outcomes between patients undergoing cystectomy with urinary diversion with or without preoperative mechanical bowel preparation .  METHODS Seventy patients underwent radical cystectomy and urinary diversion between May 2008 and August 2009 for bladder cancer . The first cohort of patients ( n = 37 ) underwent cystectomy and diversion during the period May 2008-December 2008 and underwent a preoperative mechanical bowel preparation including a clear liquid diet , magnesium citrate solution , and an enema before surgery . The second cohort of patients underwent surgery  during the period of January 2009-August 2009 ( n=33 ) . These patients were given a regular diet before surgery and did not undergo a mechanical bowel preparation except for the enema before surgery was performed to decrease rectal/colonic distention . Outcome measures included gastrointestinal and overall complications , and perioperative outcomes including recovery of bowel function . RESULTS There were no differences with regard to recovery of bowel function , time to discharge , or overall complication rates between the 2 groups . More specifically , the rate of GI complications was not different in prepped patients vs. nonprepped patients ( 22 % vs. 15 % ; P = 0.494 ) . There were no occurrences of bowel anastomotic leak , fistula , abscess , peritonitis , or surgical site infection in either group . One perioperative death occurred in the nonprepped group secondary to cardiovascular complications . CONCLUSIONS Preoperative mechanical bowel preparation prior to radical cystectomy with urinary diversion does not demonstrate any significant advantage in perioperative outcomes , including gastrointestinal complications . Further studies aim ed at measuring patient satisfaction and larger r and omized trials will be beneficial in evaluating the role of mechanical bowel preparation prior to urinary diversion
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 .