Editing Cystectomy (section)

== Patient Preparation ==

# '''<span style="color:#ff0000">Prostate cancer screening (DRE and PSA)</span>'''
#* '''If concerned for prostate cancer, attention at the time of cystectomy will be needed for complete oncologic removal of the prostate'''
# '''<span style="color:#ff0000">Marking stoma site</span>'''
#* '''Careful marking of the ostomy site to avoid interference, both in a standing and in a seated position''', is performed to maximize appliance fit and to minimize stomal irritation.
#*See [https://www.auanet.org/documents/education/clinical-guidance/Stoma-Marking.pdf AUA Stoma Marking Recommendations]
# '''<span style="color:#ff0000">Patients with a planned continent diversion should be made aware of the rare possibility of receiving an ileal conduit urinary diversion'''
# '''<span style="color:#ff0000">Bowel preparation</span>'''
#* '''Based on data from colorectal surgery, routine bowel preparation is not recommended for patients undergoing radical cystectomy with urinary diversion, especially if only ileal segments are to be used'''
# '''<span style="color:#ff0000">Antibiotic prophylaxis</span>'''
#* The choice of antibiotic should include both gram-positive coverage (skin flora) and gram-negative aerobes and anaerobes (distal small bowel and large bowel flora)
#* '''2019 AUA Best Practice Statement: Urologic Procedures and Antimicrobial Prophylaxis recommends single dose of cefazolin within 1 hour of surgical incision.[https://pubmed.ncbi.nlm.nih.gov/31441676/]'''
#*Population based study of 8,351 patients from 353 hospitals found penicillin based regimen with a beta-lactamase inhibitor (e.g. piperacillin/tazobactam, ampicillin/sublactam) was associated with a significantly reduced risk of infections events and decreased length of stay, compared to cefazolin alone.[https://pubmed.ncbi.nlm.nih.gov/28267603/]
# '''<span style="color:#ff0000">Thromboembolic prophylaxis</span>'''
#* '''Patients should undergo both mechanical thromboembolic prophylaxis''' (stockings and pneumatic compression) '''and pharmacologic prophylaxis''' before the induction of general or spinal anesthesia.
# '''<span style="color:#ff0000">μ opioid receptor antagonist</span>'''
#* '''<span style="color:#ff00ff">NCT00708201 (European Urology 2014)</span>'''
#** '''Population:''' 277 '''patients undergoing radical cystectomy'''
#** '''Randomized to oral alvimopan vs. placebo'''
#** Primary outcome: two-component end point was time to (first tolerance of solid food) and lower (first bowel movement) GI recovery.
#** '''Results:'''
#*** '''Alvimopan group had:'''
#**** '''Quicker lower GI recovery'''
#**** '''Reduced length of stay'''
#**** Fewer episodes of postoperative ileus-related morbidity
#** [https://pubmed.ncbi.nlm.nih.gov/24630419/ Lee, Cheryl T., et al.] "Alvimopan accelerates gastrointestinal recovery after radical cystectomy: a multicenter randomized placebo-controlled trial." European urology 66.2 (2014): 265-272.
#* '''Contraindicated for use in patients who have taken therapeutic doses of opioids for >7 consecutive days immediately before starting alvimopan'''
#Tranexamic Acid Infusion
#*May reduce risk of transfusion, without increasing venothromboembolism (VTE)[https://pubmed.ncbi.nlm.nih.gov/26968489/]