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ERAS for Major Urological Procedures: Evidence Synthesis and Recommendations

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Enhanced Recovery After Surgery

Abstract

Although major improvements in surgical and anesthetic techniques occurred over the past 30 years, radical cystectomy (RC) remains burdened with high morbidity. Postoperative ileus is a concern in open RC, often resulting in prolonged length of stay and increased costs. Strategies to promote bowel function recovery, such as opioid-sparing anesthesia, pain management, early mobilization, oral feeding, and appropriate use of intravenous fluids, are in the forefront. The need for a multidisciplinary approach is also enlightened.

Given tremendous improvements demonstrated by applying enhanced recovery after surgery (ERAS) protocols to colorectal surgery, RC seems to be an ideal candidate for enhancing recovery. As some key concepts in colorectal surgery cannot be applied to urological surgery and in order to tailor ERAS protocols to urological surgery, the ERAS® Society – Urology Chapter was founded, and specific guidelines for open RC were published in 2013.

As new evidence emerged in the past years, we performed a non-systematic literature review to summarize the best available evidence on ERAS application among RC patients. Potential application of ERAS concepts in less morbid but more frequently performed urological procedures such as radical prostatectomy and nephrectomy is also discussed.

We hope this review will help improve awareness of the urological community to the ERAS approach in order to increase adoption and improve postoperative outcomes.

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Authors and Affiliations

  1. Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland

    François Crettenand, Paul Martel & Ilaria Lucca

  2. USC Institute of Urology, University of Southern California, Los Angeles, CA, USA

    Siamak Daneshmand

  3. Urolife, Lausanne, Vaud, Switzerland

    Yannick Cerantola

Authors
  1. François Crettenand
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  2. Paul Martel
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  3. Ilaria Lucca
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  4. Siamak Daneshmand
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  5. Yannick Cerantola
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Correspondence to Paul Martel .

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Editors and Affiliations

  1. Department of Surgery, Örebro University Hospital, Örebro, Sweden

    Olle Ljungqvist

  2. Yeovil District Hospital NHS Foundation Trust Higher Kingston, Yeovil, Somerset, UK

    Nader K. Francis

  3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s, Hospital Harvard Medical School, Boston, MA, USA

    Richard D. Urman

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Crettenand, F., Martel, P., Lucca, I., Daneshmand, S., Cerantola, Y. (2020). ERAS for Major Urological Procedures: Evidence Synthesis and Recommendations. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_44

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