title: Peri-operative management in urinary diversion surgery: A time for change?
abstract: BACKGROUND
  Bowel preparation was established as part of the pre-operative course for patients undergoing ileal conduit formation since the late 1970's. Rationales for its use include reduction in infection and wound complications, technically easier anastomosis and earlier return to bowel function. However, recent reports have challenged this practice. Traditionally antibiotics were also administered for several days prior to surgery with the assumption that bacterial load was reduced. Modification of antibiotic protocols resulted from evidence-based findings. Furthermore, publications emphasizing the benefit of Enhanced Recovery Protocols/Programmes (ERP) have become contemporary.
  
  
  METHODS
  An online multiple-choice questionnaire (via Monkey Survey) was administered to all consultant urologists in Ireland. This national cross-sectional study evaluated the use of bowel preparation and antibiotic prophylaxis prior to urinary diversion. In addition, we also assessed consultant urologists' awareness of ERP and their views on the introduction and implementation of such a national program.
  
  
  RESULTS
  Of the 41 consultant urologists surveyed, 80.4% (n = 33) responded. 63.6% routinely used bowel preparation. Klean Prep was the most commonly used bowel preparation. 80.9% of urologists admit their patient's one-day pre-operatively for bowel preparation, with 87.8% using antibiotic prophylaxis at anesthesia induction, and 18.1% continuing the antibiotics for 24-48 h post-operatively. Although 74% of consultants are aware of ERP, only 66.6% are in favor of their national implementation.
  
  
  CONCLUSIONS
  The majority of Irish urologists use bowel preparation prior to ileal conduit formation. Substantial recent evidence has emerged showing no difference in infective complications or anastomotic leakage when bowel preparation was not used. National guidelines would be beneficial regarding the use of bowel preparation, antibiotic prophylaxis and ERP for urinary diversion surgery.
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: michaeleamonkelly@rcsi.ie.
authors.forename: M E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: B B
authors.initials: BB
authors.lastname: McGuire
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: G J
authors.initials: GJ
authors.lastname: Nason
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: G M
authors.initials: GM
authors.lastname: Lennon
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D W
authors.initials: DW
authors.lastname: Mulvin
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Galvin
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D M
authors.initials: DM
authors.lastname: Quinlan
mesh_terms: D019072:Antibiotic Prophylaxis; D002400:Cathartics / Q000008:administration & dosage; D002985:Clinical Protocols; D006801:Humans; D007494:Ireland; D019990:Perioperative Care / Q000379:methods*; D011795:Surveys and Questionnaires; D014547:Urinary Diversion
chemical_list: D002400:Cathartics
keywords: Clinical audit; Economics; Medical; Perioperative care; Urinary diversion