Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial.

Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial.

Wen Wu FM, Burkhard F, Turri F, Furrer M, Loeffel L, Thalmann G, Wuethrich P (2017) Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Urol Oncol. 2017 Oct;35(10):602.e11-602.e17.

What is already known:

Radical cystectomy surgery is well known to have a prolonged length of stay and high morbidity, in particular postoperative ileus. In this groups original study looking at ERAS for open surgery with a restricted fluid regimen they demonstrated a reduction in both hospital stay and gastrointestinal complications. However, concerns were raised about postoperative renal dysfunction after using this restrictive regimen of 1ml/kg/hr in addition to a small dose of norepinephrine.

What this paper adds:

There has been a lot of discussion over the years about restrictive vs liberal use of fluids and whilst this is not the paper to answer those questions it does suggest that there is little difference in outcomes with the two regimens. What was interesting is that the authors used an oesophageal doppler as part of their protocol but did not seem to use it to guide fluid therapy? Which goes against most ERAS guidelines whereby the recommendation is very much towards individualised or goal directed fluid therapy.

Chris Jones, Guildford. @chrisnjones