Safety of no bowel preparation before ileal urinary diversion

Abstract

Study Type – Harm (case series)Level of Evidence 4What's known on the subject? and What does the study add?Recent studies show no advantage of bowel preparation before ileal urinary diversion and that avoidance of bowel preparation led to early restoration of intestinal function and shorter hospital stay. However, this was not tested in a prospective comparison.The current study is a prospective comparison to test for the safety of omitting bowel preparation before ileal urinary diversion. This study also examines simultaneous effects of bowel preparation on the ileal flora and mucosa.OBJECTIVE To evaluate the safety of no bowel preparation before ileal reconstructive procedures of the lower urinary tract, in comparison to standard 3‐day bowel preparation. The present study also examines the effects of bowel preparation on small bowel wall and bacterial flora. PATIENTS AND METHODS This study enrolled 40 patients scheduled for radical cystectomy and ileal urinary diversion, presenting to the department of urology, Alexandria University, Alexandria, Egypt during the period from January 2009 to September 2010. Patients were prospectively randomized into two groups: Group (I) had standard 3‐day bowel preparation. Group (II) had only over‐night fasting before surgery. Intra‐operatively, one ml of ileal fluid was collected for bacteriological studies and an ileal wall biopsy was taken for histopathological examination. Postoperative complications were reported for all patients using modified Clavien system. RESULTS Both groups showed insignificant difference regarding the frequency and Clavien grade of postoperative complications (P = 0.30). Under aerobic and anaerobic conditions, 5 cases in group (I) had bacterial overgrowth of E. coli (>105) versus none in group (II) (P = 0.04). Eight patients in group (I) had sterile ileal fluid cultures versus 18 patients (90%) in group (II). No correlation could be made between would infections and the organisms isolated in ileal fluid cultures. Histopathological examination of ileal biopsies revealed mucosal edema and submucosal congestion in 9 cases in group (I) versus 2 cases in group (II) (P = 0.0310). CONCLUSIONS Omitting bowel preparation before ileal urinary diversion is safe, with no added complications. Non‐preparation of the small bowel is not associated with bacterial overgrowth.

The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

“…The test for heterogeneity among studies was not statistically significant, so the fixed-effects model was used for all comparisons. All trials reported the rate of wound infection [10,11,12,13,22,23,24]. The pooled estimate indicated that the outcome measure was not affected by the use of MBP (OR 0.84; 95% CI 0.41-1.75; p = 0.65).…”

“…Of these, 1 study lacked a control group [18], 2 studies made an inappropriate comparison [19,20], and 1 study focused on old people [21]; these studies were all excluded. In the end, 7 articles were identified for inclusion (two RCTs and five cohort studies) [10,11,12,13,22,23,24]. The overall risk of bias was unclear in 2 RCTs.…”

“…However, there were some limitations in their study. First, the sample size of this study was small because some important articles were not included [10,11,12,13]. In addition, limited BP was not really free preparation, but requested the patient to receive oral laxatives.…”

Early recovery program in the radical surgical treatment of patients with prostate cancer: Experience of the specialized hospital

“…Важность предоперационного консультирования пациентов от-носительно ведения в режиме fast track подчеркнута неоднократно [15,16]. Тем не менее на сегодняшний день нет ни одного исследования его роли среди онко-урологических пациентов.…”

“…В ряде работ пока-зано, что в колоректальной хирургии она приводит к электролитному дисбалансу, психологическому стрессу и продолжительным нарушениям перисталь-тики [20]. Многие авторы экстраполировали данные работ в колоректальной хирургии в онкоурологиче-скую практику [21], сосредоточившись, тем не менее, на цистэктомии -вмешательстве, выполняемом с ис-пользованием сегмента кишки. Наши результаты под-твердили отсутствие влияния подготовки кишечника на частоту развития осложнений (см.…”