Effect of the enhanced recovery after surgery (ERAS) protocol on the outcome of augmentation ileocystoplasty due to microcystis of tuberculous and other origin

Introduction. The implementation of enhanced recovery after surgery (ERAS) protocols, preservation of physiologic homeostasis, and reduction of perioperative stress have reduced the number of surgical complications and the length of hospital stay. These protocols have not yet found application in augmentation cystoplasty in patients with genitourinary tuberculosis.

Aim. To evaluate the effect of ERAS protocol on the results of augmentation cystoplasty and quality of life of adult patients.

Materials and Methods. The study included 99 patients with urogenital TB who underwent augmentation ileocystoplasty: 29 patients constituted the main group (using ERAS protocol) and 70 patients constituted the control group.

Results. The most severe complications (category 4 according to Clavien-Dindo scale) were absent in the main group and were observed in 4 (5.7%) patients of the control group. In the ERAS group the volume of residual urine did not exceed 100 ml, in the control group the volume more than 100 ml was observed in every fifth case. Residual urine volume between 50 ml and 100 ml was 48.5% more frequent in the control group, and ≤ 50 ml was 62.8% more frequent in the main group. The postoperative increase of the glomerular filtration rate (GFR) was noted to a greater extent in the ERAS group, by 38.4%. The physical component of health in the ERAS group increased by 6.9% on the SF-36 scale, while in the standard method group it decreased by 23%. The increase in the mental component of health was 68.8% greater in the ERAS group compared to the control group.

Conclusion. Application of the modified ERAS protocol at augmentation ileocystoplasty significantly reduces the incidence of serious postoperative complications, promotes the recovery of renal function, achievement of the best functional results, improvement of the physical component of the quality of life. The optimal capacity of the formed reservoir with a small volume of residual urine and the increase in GFR have a significant positive impact on the overall health indicator.

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