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Enhanced recovery cystectomy

Janet Baack Kukreja, Qiuling Shi, Courtney M Chang, Mohamed A Seif, Brandon M Sterling, Ting-Yu Chen, Kelly M Creel, Ashish M Kamat, Colin P Dinney, Neema Navai, Jay B Shah, Xin Shelley Wang
BACKGROUND: Bladder cancer is a disease of the elderly that is associated with high morbidity in those treated with radical cystectomy. In this observational study of patients with bladder cancer undergoing radical cystectomy, we analyzed and compared patient-reported outcomes from those treated with Enhanced Recovery After Surgery (ERAS) methods versus those who received traditional perioperative care. METHODS: We enrolled patients who underwent radical cystectomy at a high-volume tertiary care referral center from November 2013 to December 2016, when the ERAS concept was being introduced into postoperative care at our institution...
March 1, 2018: Surgical Innovation
Shawn Dason, Alvin C Goh
PURPOSE OF REVIEW: More than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery. RECENT FINDINGS: In this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles...
March 15, 2018: Current Urology Reports
John A Brockman, Joel Vetter, Vicky Peck, Seth A Strope
OBJECTIVES: To determine whether an enhance recovery protocol for radical cystectomy patient affected the length of stay or the number and type of readmissions that occurred after hospital discharge. METHODS: We prospectively assessed 152 cystectomy patients after initiation of the pathway. These patients were compared to the previous 147 patient operated on prior to the pathway initiation. Eligible patients were those undergoing radical cystectomy with any diversion at our institution...
March 12, 2018: Urology
Rafael Uña Orejón, Estrella Mateo Torres, Iván Huercio Martínez, Cristina Jofré Escudero, Juan Gómez Rivas, Jesús Díez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol...
March 2018: Archivos Españoles de Urología
C Adam Lorentz, Kirven Gilbert, Mehrdad Alemozaffar, Dattatraya Patil, Christopher P Filson
BACKGROUND: Enhanced recovery pathways after radical cystectomy attempt to decrease length of hospitalization, but might increase risk of readmission after discharge. We evaluated the relationship between length of stay and readmission after uncomplicated hospitalization for bladder cancer patients treated with radical cystectomy. PATIENTS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified bladder cancer patients who were treated with radical cystectomy from 2011 to 2015...
February 2, 2018: Clinical Genitourinary Cancer
Vito Palumbo, Gianluca Giannarini, Alessandro Crestani, Marta Rossanese, Mattia Calandriello, Vincenzo Ficarra
OBJECTIVES: To assess whether an Enhanced Recovery After Surgery pathway was associated with a faster bowel function recovery and no increase in morbidity compared to standard perioperative care in a contemporary series of patients undergoing radical cystectomy. METHODS: A prospective single-center single-surgeon cohort of 114 consecutive patients treated with open radical cystectomy between July 2013 and June 2016 was analyzed. A study group of 74 patients with Enhanced Recovery After Surgery pathway was compared with a control group of 40 patients with standard perioperative care...
February 15, 2018: Urology
Roger Li, Michael Metcalfe, Janet Kukreja, Neema Navai
Background: Currently, a diagnosis of non-organ confined bladder cancer (NOCBCa) confers a grave prognosis. The mainstay of treatment consists of systemic chemotherapy. However, it must be recognized that NOCBCa is a heterogeneous disease state with important clinical distinctions. While surgical extirpation has traditionally been regarded as overly aggressive for all NOCBCa patients, its utility as part of a multimodal treatment strategy in various clinical scenarios has not been thoroughly investigated...
January 20, 2018: Bladder Cancer
Soroush T Bazargani, Saum Ghodoussipour, Beverly Tse, Gus Miranda, Jie Cai, Anne Schuckman, Siamak Daneshmand, Hooman Djaladat
PURPOSE: To evaluate the association between intraoperative fluid intake and postoperative complications in patients who underwent radical cystectomy (RC) for bladder cancer with an enhanced recovery protocol. METHODS: 287 patients underwent open RC with enhanced recovery protocol (ERAS) from 2012 to 2016. 107 were excluded; non-urothelial (30), palliative (37), had adjunct procedures or not-consented (40). We prospectively evaluated intraoperative fluid intake (crystalloid, colloid and blood) and correlated with length of stay, 30- and 90-day complications...
January 3, 2018: World Journal of Urology
Bettina L Broughton, Barbara Baron, Maureen Kiernan, Janet Baack-Kukreja, Virginia E LaFaro, Rita Larmon, Kay Rust, Bethany A Schempp, Janis Yovanovich
Cystectomy is a complex procedure with a tenuous perioperative course. Enhanced recovery programs (ERPs) are bundle strategies, developed to enhance the recovery of surgical patients. This article outlines the components of an ERP for cystectomy patients from a nursing implementation perspective.
January 2017: Urologic Nursing
Marc P Schneider, Lukas M Löffel, Marc A Furrer, Fiona C Burkhard, Bettina Kleeb, Michele Curatolo, Patrick Y Wuethrich
Thoracic epidural analgesia (TEA) enhances recovery after bowel surgery. Early postoperative prolonged-release oral formulation of oxycodone or oxycodone/naloxone is potentially useful as a second analgesic step to reduce the duration of TEA. We hypothesized that oxycodone would decrease the duration of TEA and combined with naloxone preserve gastrointestinal function. Ninety patients undergoing open cystectomy and urinary diversion were enrolled in this randomized double-blind, three-arm, parallel-group, placebo-controlled single-center trial between September 2015 and February 2017...
March 2018: Pain
C S Voskuilen, E E Fransen van de Putte, J Bloos-van der Hulst, E van Werkhoven, W M de Blok, B W G van Rhijn, S Horenblas, R P Meijer
PURPOSE: Cystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube...
November 22, 2017: World Journal of Urology
Ian Maloney, Daniel C Parker, Michael S Cookson, Sanjay Patel
Background: Enhanced recovery pathways, also known as fast-track protocols, have been adopted since the early 2000s by various surgical specialties with the goal of improving patient outcomes and reducing the cost burden of major surgery on the health care system. Objective: To review the scientific literature on the origin of enhanced recovery pathways, track the contemporary utilization of such practices for patients undergoing radical cystectomy, and analyze the available data regarding their effect on morbidity, mortality, and treatment cost...
October 27, 2017: Bladder Cancer
David S Wang
No abstract text is available yet for this article.
December 2017: Journal of Urology
Wei Shen Tan, Mae-Yen Tan, Benjamin W Lamb, Ashwin Sridhar, Anna Mohammed, Hilary Baker, Senthil Nathan, Timothy Briggs, Melanie Tan, John D Kelly
OBJECTIVE: To assess the cumulative effect of an enhanced recovery after surgery (ERAS) pathway and minimally invasive robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) in comparison with open radical cystectomy (ORC) on length of hospital stay (LOS) and peri-operative outcomes. MATERIALS AND METHODS: Between February 2009 and October 2017, 304 radical cystectomy cases were performed at a single institution (ORC, n = 54; robot-assisted radical cystectomy [RARC], n = 250)...
November 10, 2017: BJU International
Sebastian Karl Frees, Jonathan Aning, Peter Black, Werner Struss, Robert Bell, Claudia Chavez-Munoz, Martin Gleave, Alan I So
PURPOSE: There is a lack of evidence demonstrating the benefits of using enhanced recovery after surgery protocols (ERAS). Here, we propose to use a randomized clinical pilot study to demonstrate the benefits and feasibility of implementing ERAS versus standard protocols (SP) in patients undergoing radical cystectomy (RC) and urinary diversion. METHODS: 27 consecutive patients undergoing RC were included in the study. 12 patients were prospectively randomized to follow an ERAS protocol and 15 patients followed an SP...
February 2018: World Journal of Urology
Tianxin Lin, Kaiwen Li, Hao Liu, Xueyi Xue, Ning Xu, Yong Wei, Zhiwen Chen, Xiaozhou Zhou, Lin Qi, Wei He, Shiyu Tong, Fengshuo Jin, Xudong Liu, Qiang Wei, Ping Han, Xin Gou, Weiyang He, Xu Zhang, Guoqiang Yang, Zhoujun Shen, Tianyuan Xu, Xin Xie, Wei Xue, Ming Cao, Jin Yang, Jianyun Hu, Fubao Chen, Peijun Li, Guangyong Li, Tong Xu, Ye Tian, Wenying Wang, Dongkui Song, Lei Shi, Xiaoming Yang, Yang Yang, Benkang Shi, Yaofeng Zhu, Xigao Liu, Jinchun Xing, Zhun Wu, Kaiyan Zhang, Wei Li, Chaozhao Liang, Cheng Yang, Wei Li, Jinchun Qi, Chuanliang Xu, Weidong Xu, Liqun Zhou, Lin Cai, En'ci Xu, Weizhong Cai, Minggao Weng, Yiming Su, Fangjian Zhou, Lijuan Jiang, Zhuowei Liu, Qiuhong Chen, Tiejun Pan, Bo Liu, Yu Zhou, Xin Gao, Jianguang Qiu, Jie Situ, Cheng Hu, Shan Chen, Yupeng Zheng, Jian Huang
PURPOSE: Enhanced recovery after surgery (ERAS) has played an important role in recovery management for radical cystectomy with ileal urinary diversion (RC-IUD). This study is to evaluate ERAS compared with the conventional recovery after surgery (CRAS) for RC-IUD. METHODS: From October 2014 and July 2016, bladder cancer patients scheduled for curative treatment from 25 centers of Chinese Bladder Cancer Consortium were randomly assigned to either ERAS or CRAS group...
January 2018: World Journal of Urology
Alice Semerjian, Niv Milbar, Max Kates, Michael A Gorin, Hiten D Patel, Heather J Chalfin, Steven M Frank, Christopher L Wu, William W Yang, Deb Hobson, Lindsay Robertson, Elizabeth Wick, Mark P Schoenberg, Phillip M Pierorazio, Michael H Johnson, C J Stimson, Trinity J Bivalacqua
OBJECTIVE: To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. MATERIALS AND METHODS: Our ERAS protocol was implemented for RC in December 2015...
January 2018: Urology
John S McGrath, Raj S Pruthi
No abstract text is available yet for this article.
November 2017: Nature Reviews. Urology
Rafael Uña Orejón, Ivan Huercio Martinez, Estrella Mateo Torres, Cristina Jofré Escudero, Juan Gomez Rivas, Jesús Diez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVES: The intraoperative goaldirected fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT...
October 2017: Archivos Españoles de Urología
Daniel Zainfeld, Hooman Djaladat
Coordinated multidisciplinary perioperative care through enhanced recovery protocols has improved outcomes within urologic surgery. Continued development and refinement of enhanced recovery after surgery (ERAS) pathways will further augment the care of patients undergoing all urologic procedures. Among the challenges, moving forward is identification of barriers to ERAS adoption by providers, maximizing adherence among patients, standardization of ERAS pathways through establishment of evidence-based principles, and application in additional complex urologic procedures beyond radical cystectomy...
October 2017: Journal of Surgical Oncology
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