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Elimination of preoperative mechanical bowel preparation in patients undergoing cystectomy and urinary diversion.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Raynor, Mathew C. Lavien, Garjae Nielsen, Matthew Wallen, Eric M. Pruthi, Raj S.
Description	Country affiliation: United States Author Affiliation: Raynor MC ( Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.)
Abstract	INTRODUCTION: The utility of a preoperative mechanical bowel preparation prior to bowel surgery has recently been questioned. The purpose of this study is to compare the perioperative outcomes between patients undergoing cystectomy with urinary diversion with or without preoperative mechanical bowel preparation. METHODS: Seventy patients underwent radical cystectomy and urinary diversion between May 2008 and August 2009 for bladder cancer. The first cohort of patients (n = 37) underwent cystectomy and diversion during the period May 2008-December 2008 and underwent a preoperative mechanical bowel preparation including a clear liquid diet, magnesium citrate solution, and an enema before surgery. The second cohort of patients underwent surgery during the period of January 2009-August 2009 (n=33). These patients were given a regular diet before surgery and did not undergo a mechanical bowel preparation except for the enema before surgery was performed to decrease rectal/colonic distention. Outcome measures included gastrointestinal and overall complications, and perioperative outcomes including recovery of bowel function. RESULTS: There were no differences with regard to recovery of bowel function, time to discharge, or overall complication rates between the 2 groups. More specifically, the rate of GI complications was not different in prepped patients vs. nonprepped patients (22% vs. 15%; P = 0.494). There were no occurrences of bowel anastomotic leak, fistula, abscess, peritonitis, or surgical site infection in either group. One perioperative death occurred in the nonprepped group secondary to cardiovascular complications. CONCLUSIONS: Preoperative mechanical bowel preparation prior to radical cystectomy with urinary diversion does not demonstrate any significant advantage in perioperative outcomes, including gastrointestinal complications. Further studies aimed at measuring patient satisfaction and larger randomized trials will be beneficial in evaluating the role of mechanical bowel preparation prior to urinary diversion.
File Format	HTM / HTML
ISSN	10781439
Issue Number	1
Volume Number	31
e-ISSN	18732496
Journal	Urologic Oncology: Seminars and Original Investigations
Language	English
Publisher	Elsevier
Publisher Date	2013-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Urology Discipline Oncology Cystectomy Postoperative Complications Preoperative Care Methods Urinary Bladder Neoplasms Surgery Urinary Diversion Adult Aged Aged, 80 And Over Female Follow-up Studies Humans Length Of Stay Male Middle Aged Neoplasm Staging Standards Prognosis Retrospective Studies Pathology Journal Article
Content Type	Text
Resource Type	Article
Subject	Urology Oncology

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