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Enhanced recovery programmes for patients undergoing radical cystectomy

Nature Reviews Urology volume 11, pages 437–444 (2014)Cite this article

Subjects

Key Points

  • Enhanced recovery programmes (ERPs) are multimodal and have preoperative, intraoperative and postoperative components

  • The surgery itself is only one of many important steps; others include preoperative patient education, postoperative multimodal analgesia and early commencement of enteral nutrition

  • Reappraisal of existing ERPs, assessment of patient experience and identification of areas of improvement are key to ensuring a consistently high level of care

  • Discharge criteria are the tolerance of a normal diet, adequate pain control with oral analgesia, competence with either stoma care (conduit) or catheter care (neobladder) and the patient feeling adequately supported

  • Follow-up support includes follow-up telephone calls, a scheduled date for clinical review and an emergency contact

Abstract

Radical cystectomy is associated with high rates of surgical morbidity. The magnitude of the surgical insult is associated with the degree of stress response, particularly in ageing patients with multiple comorbidities. Attempts to limit this response and identify areas of improvement with respect to patient selection and optimization, anaesthesia, surgical technique and postoperative care underpin the multimodal approach to enhanced recovery pathways. No single intervention significantly reduces morbidity, but the combination of many interventions at all levels of the pathway is likely to accelerate the patient journey from diagnosis to return to normal function.

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Authors and Affiliations

  1. University Hospital Southampton, Tremona Road, SO16 6YD, Hampshire, UK

    Julian Smith

  2. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, 27599-7235, NC, USA

    Raj S. Pruthi

  3. Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, Exeter, UK

    John McGrath

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J.S. researched data for the article and wrote the article. All authors made a substantial contribution to discussion of its content and reviewed/edited the manuscript before submission.

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Smith, J., Pruthi, R. & McGrath, J. Enhanced recovery programmes for patients undergoing radical cystectomy. Nat Rev Urol 11, 437–444 (2014). https://doi.org/10.1038/nrurol.2014.164

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