Evaluation of mechanical bowel preparation methods in urinary diversion surgery.
OBJECTIVE
We performed the first prospective, randomized, multi-center comparison of overall quality and patient tolerability of polyethylene glycol (PEG) and sodium phosphate (NaP) solution for mechanical bowel preparation prior to urinary diversion surgery.


METHODS
Between 2001 and 2003, 36 patients at six institutions underwent major urological reconstructive surgery incorporating small intestine (35 radical cystectomy with urinary diversion and 1 bladder augmentation). Patients were prospectively randomized to receive either oral polyethylene glycol (group 1, n = 16) or sodium phosphate (group 2, n = 20) for mechanical bowel preparation prior to surgery, according to our multi-institutional IRB-approved protocol. All patients completed a questionnaire the morning of surgery to assess the tolerability and side effects of each agent. Quality of the bowel preparation was recorded based on intraoperative findings of the attending surgeon, who was blinded to the preparation method.


RESULTS
Both bowel cleansing regimens were safe and well tolerated. Patient-reported ease of use and subjective incidence of side effects were statistically similar in the two groups, and a statistically non-significant trend to more bloating in the PEG group was also noted (p = 0.085). Surgeon-scored overall quality of preparation adequacy revealed no significant differences between oral sodium phosphate and polyethylene glycol solutions (p = 0.555). Postoperative complications were rare for each bowel preparation agent.


CONCLUSIONS
Performance characteristics of oral sodium phosphate and polyethylene glycol bowel preparations appear to be similar. Each method is safe, efficacious, and well-tolerated when used prior to urinary diversion surgery. The cost for the NaP preparation was $1.40 versus $19.70 for the PEG bowel preparation. Sodium phosphate may have a slight advantage because of its convenience and economic advantage.
Morey
Allen F
AF
Department of Surgery, Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
Evans
L Andrew
LA
McDonough
R Clayton
RC
Park
Alyssa M
AM
Sexton
Wade J
WJ
Basler
Joseph W
JW
Santucci
Richard A
RA
Amling
Christopher L
CL
O'Reilly
Keith J
KJ
D002400:Cathartics / Q000494:pharmacology*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010710:Phosphates / Q000494:pharmacology*; D011092:Polyethylene Glycols / Q000494:pharmacology*; D011300:Preoperative Care / Q000379:methods*; D014547:Urinary Diversion
D002400:Cathartics; D010710:Phosphates; D011092:Polyethylene Glycols; C018279:sodium phosphate