• Raj S Pruthi, Judy Chun, and Marc Richman.
• Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
• Urology. 2003 Oct 1;62(4):661-5; discussion 665-6.

ObjectivesTo outline our current perioperative treatment of patients undergoing radical cystectomy and urinary diversion, which uses advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge, and thereby overall improvement in patient recovery and outcome after this procedure.MethodsForty consecutive patients underwent radical cystectomy and urinary diversion with curative intent from 2001 to 2002. A care plan was followed for all patients and included improvements in preoperative, intraoperative, and postoperative care. The preoperative care included limited outpatient bowel preparation with sodium phosphate solution and patient education. Operative modifications included reduced incision length, initial preperitoneal dissection, and the use of internal surgical stapling devices. The postoperative care included the use of prokinetic agents, early nasogastric tube removal, the use of non-narcotic analgesics, and early institution of an oral diet. The outcomes with regard to time to institution of an oral diet, tolerance of a regular diet, and hospital discharge were assessed.ResultsThe mean surgical time was 3.9 hours, and the mean estimated blood loss was 573 mL. The mean time to the institution of a clear liquid diet was 2.0 days and to a regular diet was 4.2 days. The mean time to hospital discharge was 5.1 days. No statistically significant differences were found in the time to resumption of a regular diet or to discharge between patients undergoing ileal conduits versus orthotopic ileal neobladders. Only 1 patient had any gastrointestinal dysfunction (ileus), and this patient was discharged on postoperative 7. No patient had any delayed complications involving problems with diet intolerance or other gastrointestinal dysfunction. The results of the current series were compared with those of historical controls.ConclusionsAdvancements in preoperative, intraoperative, and postoperative management have together been successfully used in our patient population to reduce morbidity and improve recovery with regard to the early institution of an oral diet and early hospital discharge.

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