Enhanced Recovery After Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs

Overview

Journal Eur Urol

Specialty Urology

Date 2016 Mar 14

PMID 26970912

Citations 89

Authors

Raed A Azhar

Bernard Bochner

James Catto

Alvin C Goh

John Kelly

Hiten D Patel

Raj S Pruthi

George N Thalmann

Mihir Desai

Affiliations

Soon will be listed here.

Abstract

Context: Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times.

Objective: To overview the use and key elements of ERAS pathways, and define needs for future clinical trials.

Evidence Acquisition: A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery."

Evidence Synthesis: We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters.

Conclusions: ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery.

Patient Summary: This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.

Citing Articles

Curative effect of laparoscopic ureteral end-to-side anastomosis at the pelvic level for a duplex kidney in children.

Bian Z, Xiong G, Liu T, Zhi Y, Liu M Front Pediatr. 2025; 13:1509039.

PMID: 40046853 PMC: 11880260. DOI: 10.3389/fped.2025.1509039.

Same Day Discharge After Robotic Radical Prostatectomy.

Najdawi F, Alcantar J, Lee D, Shahait M, Dobbs R Curr Urol Rep. 2025; 26(1):27.

PMID: 39913027 DOI: 10.1007/s11934-025-01254-8.

Enhanced recovery after surgery protocol optimizes results and cost of laparoscopic radical nephroureterectomy.

Shi J, Chen S, Nie J, Xiong K, Wang G, Qian K BMC Surg. 2025; 25(1):14.

PMID: 39780183 PMC: 11715194. DOI: 10.1186/s12893-025-02758-3.

Personalized Mobile App-Based Program for Preparation and Recovery After Radical Prostatectomy: Initial Evidence for Improved Outcomes From a Prospective Nonrandomized Study.

Martini A, Kesch C, Touzani A, Calleris G, Buhas B, Abou-Zahr R J Med Internet Res. 2024; 26:e55429.

PMID: 39671590 PMC: 11681284. DOI: 10.2196/55429.

A review of enhanced recovery after surgery concept in perioperative radical prostatectomy for prostate cancer.

Wu C, Jiang X, Shi Y, Lv Z J Robot Surg. 2024; 19(1):9.

PMID: 39585492 DOI: 10.1007/s11701-024-02170-8.

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