Enhanced recovery after surgery (ERAS) protocol in augmentation cystoplasty for patients with urogenital tuberculosis

Introduction. The implementation of an Enhanced Recovery After Surgery (ERAS) protocol may improve quality of life in patients undergoing subtotal cystectomy followed by intestinal reconstruction.

Objective. To evaluate the outcomes of subtotal cystectomy with intestinal reconstruction and postoperative recovery in patients managed using a tailored ERAS protocol.

Materials & methods. The study included 99 patients who underwent subtotal cystectomy for microcystitis with subsequent intestinal augmentation. The primary group, managed with the ERAS protocol, comprised 29 patients, while the control group included 70 patients.

Results. Utilisation of the ERAS protocol significantly reduced the incidence of postoperative complications according to the Clavien-Dindo classification. The ERAS group showed a higher proportion of patients with improved glomerular filtration rate (65.5% vs. 27.1%). A functional capacity of the neobladder exceeding 200 ml was more frequently observed in the ERAS cohort (69.0% vs. 34.3%). Residual urine volume greater than 100 ml was absent in the ERAS group but present in 20% of controls. Passage of flatus occurred on average 16h postoperatively in the ERAS group, compared to 25h in controls. Mean time to first defecation was 35h in the ERAS group and 49h in the control group.

Conclusion. Application of the ERAS protocol in patients undergoing augmentation ileocystoplasty substantially decreases postoperative complications, facilitates better renal function recovery, achieves superior functional voiding parameters, and accelerates restoration of bowel motility.

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