Introduction of the ERAS protocol is clearly feasible in cystectomy, and may improve clinical outcomes in terms of faster return of bowel function and reduction of readmission within 30 days. However, more and larger studies are needed to prove the efficacy of ERAS for patients undergoing ORC.

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Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.

It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

urinary diversion at seven Swedish hospitals. During a qualitative phase we identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks (RR) with 95% confidence interval. RESULTSWe received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The RR for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a RR of 2.1 (1.4-3.2) for having a symptomatic UTI. CONCLUSIONSWe could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy with urinary diversion. Patients with diabetes mellitus have a greater risk of contracting a UTI. KEYWORDS urinary tract infections, hygiene, cystectomy, urinary diversionStudy Type -Symptom prevalence (retrospective cohort) Level of Evidence 2b OBJECTIVESTo determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections (UTIs) in patients treated by cystectomy for urinary bladder cancer. PATIENTS AND METHODSWe attempted to contact during their follow-up all men and women aged 30-80 years who had undergone cystectomy and INTRODUCTIONThe prevalence of bacteriuria, intermittent or continuous, is high after cystectomy with urinary diversion for bladder cancer; 77-94% of patients after cystectomy have bacteria in the urine, irrespective of the type of urinary diversion [1][2][3][4]. About a quarter of patients with a urinary diversion contract a symptomatic UTI each year [5][6][7]. After 4 years of follow-up, Wood et al. [7] reported that ≈ 60% of patients still alive had contracted a UTI, defined as > 10 000 colonyforming units, plus symptoms of UTI such as urgency, abdominal pain, frequency and dysuria, or > 100 000 colony-forming units but treated with antibiotics, with or without symptoms. Suggested risk factors for symptomatic UTI include residual urine [4], intermittent catheterization [7,8] and postrenal obstruction [6]. Recurrent UTIs might increase the risk of serious UTI with urosepsis [7].Patients after cystectomy lack the normal urinary epithelial defence system [9] and this might increase the risk of UTI in this group of cancer survivors. For a UTI to occur bacteria must be present, but the simple presence of bacteria does not necessarily cause the UTI [3]. Hygienic measures might lessen the concentration of bacteria but it is not known whether hygienic measures applied during emptying of urine from a urinary diversion decrease the risk of contracting a UTI in cystectomized patients.The fever and pain caused by a UTI can be highly distressing; Henningsohn et al. [5] showed that a UTI decreased the affected individual's self-assessed quality of life. If we can lessen the...