Urology

The ERAS® Society – Urology Chapter was officially formed at the 2016 World Congress in Lisbon. The group was chaired by Dr Yannick Cerantola (Switzerland) until 2018 and is now chaired by Dr Sia Daneshmand (USA).

With over 500,000 new diagnoses each year and 200,000 deaths, bladder cancer (BC) is one of the most common and lethal malignancies worldwide [1]. A quarter of all cases are muscle invasive with significant risk of mortality. While less lethal, non-muscle invasive disease has a risk for recurrence and progression [2, 3]. These risks are greatest in patients with T1 disease, high-grade disease after failure of intravesical therapy and in certain variant histologies [4]. The management of BC is therefore aggressive with radical cystectomy (RC), pelvic lymphadenectomy and urinary diversion considered standard of care for muscle invasive disease, certain high-risk non-muscle invasive diseases and after failure of intravesical or trimodal therapy [4-6].

While RC leads to improved long-term survival, the operation is one of the most complex urological operations with risk of perioperative morbidity. Postoperative length of stay (LOS) has been reported up to 17 days in European studies and up to 9 days in US registry studies [7, 8]. Complications occur in up to 60% of patients and readmissions in 30% [9]. The adoption by urologists of enhanced recovery after surgery (ERAS) protocols has dramatically improved the perioperative care of patients undergoing RC [10, 11]. These protocols include preoperative, intraoperative, and postoperative modifications to enhance recovery and reduce stress following surgery. In 2013, the ERAS Society published guidelines for perioperative care after radical cystectomy [12]. Since the publication of these guidelines and initial implementation of ERAS protocols, evidence supporting the use of ERAS after radical cystectomy has grown.

Acceptance of and adherence to these protocols will continue to improve with refinement of existing interventions and development of new ones. Current work focuses on improving outcomes beyond the index hospitalization and includes efforts to decrease late complications, readmissions, costs and the overall patient experience.