title: The impact of mechanical bowel preparation on postoperative complications for patients undergoing cystectomy and urinary diversion.
abstract: OBJECTIVE
  The benefit of routine mechanical bowel preparation for patients undergoing radical cystectomy is not well established. We compared postoperative complications in patients who did or did not undergo mechanical bowel preparation before radical cystectomy.
  
  
  METHODS
  In 2008 a single surgeon (GDS) performed open radical cystectomy with an ileal conduit or orthotopic neobladder in 105 consecutive patients with preoperative mechanical bowel preparation consisting of 4 l GoLYTELY®. In 2009 radical cystectomy with an ileal conduit or orthotopic neobladder was performed in 75 consecutive patients without mechanical bowel preparation. A comprehensive database provided clinical, pathological and outcome data.
  
  
  RESULTS
  All patients had complete perioperative data available. The 2 groups were similar in age, Charlson comorbidity score, diversion type, receipt of neoadjuvant radiation or chemotherapy, blood loss, hospital stay, time to diet and pathological stage. Postoperative urinary tract infection, wound dehiscence and perioperative death rates were similar in the 2 groups. Clostridium difficile infection developed within 30 days of surgery in 11 of 105 vs 2 of 75 patients with vs without mechanical bowel preparation (p = 0.08). When adjusted for the annual hospital-wide C. difficile rate, the difference remained insignificant (p = 0.21). Clavien grade 3 or greater abdominal and gastrointestinal complications, including fascial dehiscence, abdominal abscess, small bowel obstruction, bowel leak and entero-diversion fistula, developed in 7 of 105 patients with (6.7%) vs 11 of 75 without (14.7%) mechanical bowel preparation (p = 0.08).
  
  
  CONCLUSIONS
  The use of mechanical bowel preparation for patients undergoing radical cystectomy with an ileal conduit or orthotopic neobladder does not seem to impact the rates of perioperative infectious, wound and bowel complications. Larger series with multiple surgeons are necessary to confirm these findings.
authors.affiliation: Section of Urology, University of Chicago Medical Center, Chicago, Illinois, USA. michael.large@uchospitals.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Large
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Kiriluk
authors.forename: G Joel
authors.initials: GJ
authors.lastname: DeCastro
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.forename: Sandip
authors.initials: S
authors.lastname: Prasad
authors.forename: Gautam
authors.initials: G
authors.lastname: Jayram
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Weber
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D002400:Cathartics / Q000627:therapeutic use*; D015653:Cystectomy; D004573:Electrolytes / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D014547:Urinary Diversion
chemical_list: D002400:Cathartics; D004573:Electrolytes; C033608:Golytely; D011092:Polyethylene Glycols