Current practice patterns in the perioperative management of patients undergoing radical cystectomy: Results from a global survey

Sharma, Gopal; Krishna, Murali; Pareek, Tarun; Bora, Girdhar S.; Mavuduru, Ravimohan; Mete, Uttam; Singh, Shrawan Kumar; Patel, Hitendra

doi:10.1016/j.urolonc.2022.01.003

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…Studies showed that another important predictor of morbidity and mortality after radical cystectomy was the surgeon's and hospital's volume [22][23][24] . However, despite improvement in surgical techniques and use of enhanced postoperative recovery protocols, ORC remains one of the largest and most demanding surgical procedures performed by urologists 25 . Major complications occur in approximately 5% and minor complications in 30% of cases 5,6 .…”

Section: Discussionmentioning

confidence: 99%

Open Radical Cystectomy: Single Center Results and Outcomes in the Last Five Years

Čikić

2023

ACC

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Radical cystectomy is a therapeutic modality of choice for many patients with muscle-invasive bladder cancer. We conducted a retrospective study of open radical cystectomies performed at a single Center from January 2017 to January 2022. Decision on the urinary diversion type was based on tumor stage, comorbidities, patient age, general condition and preferences. There were 19.5% of female and 80.5% of male patients, median age 67 (range 38-90) years. We performed 96 (44.7%) ureterocutaneostomies (UCS), 67 (31.2%) ileal conduit derivations, and 52 (24.2%) orthotopic neobladder derivations (OND). There were 17 (7.9%) complications after UCS, 7 (3.2%) after incontinent urinary diversion, and 7 (3.2%) after OND. Fifty-five (25.6%) patients developed early complications, of which 31 (14.4%) during the initial hospitalization period, and 24 (11.2%) required re-hospitalization in the 30-day postoperative period. The most common wound-related complication was wound dehiscence, most typically caused by infection. The main reason for readmission was urosepsis. The 30-day mortality rate was 0.9%. Late complications that occurred 30 days after the operation were found in 39 (18.1%) cases. Bladder cancer is a high-mortality disease that requires a multidisciplinary and personalized approach. Further development of multidisciplinary teams, perioperative and postoperative care, and follow-up strategy is needed to improve the oncologic and functional outcomes of this procedure.

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Section: Discussionmentioning

confidence: 99%

Open Radical Cystectomy: Single Center Results and Outcomes in the Last Five Years

Čikić

2023

ACC

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“…Duration of antibiotics was 24, 48, and more than 48 h for 47.6, 16.9, and 35.2%, respectively. In Nordic countries, around 73% of the centres gave a single perioperative dose, and the rest gave antibiotics for 1–3 days [39 ▪ ].…”

Section: Compliancementioning

confidence: 99%

Prevention and management of urinary tract infections after cystectomy

Berndl¹,

Frerichmann

Berndl³

2023

Current Opinion in Urology

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Purpose of reviewTo give an overview of the most relevant recent literature about urinary tract infections (UTI) after radical cystectomy and to discuss them in the context of new individualized therapy approaches and possible preventive measures.Recent findingsUTI following radical cystectomy is a common complication associated with significant morbidity and readmission risk. Recent literature focuses on the identification of risk factors and the optimization of management. The risk factors most commonly associated with increased risk for UTI were perioperative blood transfusions and orthotopic neobladder (ONB). Furthermore, the effect of perioperative antibiotic regimens on rates of postoperative infections has been studied, but no consistent significant changes in UTI rates have yet been identified. Guidelines should be based on urologic studies and, wherever appropriate, should be uniform in design to encourage more frequent adherence. Furthermore, understanding the pathomechanisms leading to the development of UTI after radical cystectomy needs to be more central to discussions.SummaryUniform definition of UTI, characteristics of bacterial pathogens involved, and type and duration of antibiotics used and identification of clinical risk factors must be the focus of well designed prospective studies to enable reduction of the most common complication after radical cystectomy.

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“…51 Given the higher risk, enhanced recovery after cystectomy (ERAC) pathways, modeled after the enhanced recovery after surgery (ERAS) pathways in colorectal procedure complications, have been recommended development by urologic associations. 52,53 Perioperative analgesia is one component of this ERAC protocol recommending multimodal opioid-sparing analgesics such as non-steroidal anti-inflammatory drugs, epidural blocks, and locoregional blocks to enhance recovery. 52,53 One global survey study found half of the respondents still used opioids with or without non-steroidal anti-inflammatory drugs and limited use of epidural analgesia.…”

Section: Opioids In Cystectomymentioning

confidence: 99%

“…52,53 Perioperative analgesia is one component of this ERAC protocol recommending multimodal opioid-sparing analgesics such as non-steroidal anti-inflammatory drugs, epidural blocks, and locoregional blocks to enhance recovery. 52,53 One global survey study found half of the respondents still used opioids with or without non-steroidal anti-inflammatory drugs and limited use of epidural analgesia. 53 There have been a couple retrospective studies demonstrating epidural usage in radical cystectomy patients to be associated with longer hospital stay times and increased complications.…”

Section: Opioids In Cystectomymentioning

confidence: 99%

“…52,53 One global survey study found half of the respondents still used opioids with or without non-steroidal anti-inflammatory drugs and limited use of epidural analgesia. 53 There have been a couple retrospective studies demonstrating epidural usage in radical cystectomy patients to be associated with longer hospital stay times and increased complications. 54,55 Another prospective implementation of a nonopioid perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy demon-Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?…”

Section: Opioids In Cystectomymentioning

confidence: 99%

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Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

Anderson

Cao

Zhou

et al. 2022

Health Psychology Research

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Urologic procedures (both open and minimally invasive) can cause pain due to the surgery itself, devices placed, and post-operative issues. Thus, pain management is important for every post-procedure recovery period. Opioid use post-surgery is common and often over-prescribed contributing to persistent use by patients. In this article, we review the extent of opioid use in pediatric urologic procedures, vasectomy, endourologic procedures, penile implantation, urogynecologic procedures, prostatectomy, nephrectomy, cystectomy, and scrotal/testicular cancer surgery. Generally, we have found that institutions do not have a standardized protocol with a set regimen to prescribe opioids, resulting in more opioids being prescribed than needed and patients not properly disposing of their unused prescriptions. However, many institutions recognize their opioid overuse and are implementing new multimodal opioid-sparing analgesics methods such as non-opioid peri-operative medications, minimally invasive robotic surgery, and nerve blocks or local anesthetics with varying degrees of success. By shedding light on these opioid-free methods and prescription protocols, along with improved patient education and counselling, we hope to bring awareness to institutions and decrease unnecessary opioid use.

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Current practice patterns in the perioperative management of patients undergoing radical cystectomy: Results from a global survey

Cited by 4 publications

References 19 publications

Open Radical Cystectomy: Single Center Results and Outcomes in the Last Five Years

Open Radical Cystectomy: Single Center Results and Outcomes in the Last Five Years

Prevention and management of urinary tract infections after cystectomy

Opioids in Urology: How Well Are We Preventing Opioid Dependence and How Can We Do Better?

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