# Enhanced recovery after radical cystectomy (ERAS pathway for bladder removal)

Source: https://onco.cc/protocols/enhanced-recovery-after-radical-cystectomy/  
OnCo record `enhanced-recovery-after-radical-cystectomy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery after bladder removal means getting fitter beforehand, no bowel preparation and no long fast, pain relief that spares opioids, the stomach tube out at the end of the operation, and four weeks of blood clot injections, in a hospital that does at least 20 of these operations a year.

## Summary

The EAU 2026 bladder cancer guideline gives four strong recommendations around cystectomy: do not offer preoperative bowel preparation; use 'fast track' measures to shorten bowel recovery; offer pharmacological VTE prophylaxis such as LMWH from the first day after surgery for at least four weeks; and do at least 20 cystectomies per hospital per year. Its text adds that there is no universal ERAS protocol for cystectomy, that prehabilitation may help but lacks randomised trials, and that ERAS reduced ileus from 22% to 7.3% at the cost of somewhat more pain. The ERAS Society guideline (2013) found evidence for only 7 of 22 items (no bowel preparation, early nasogastric tube removal, Doppler-guided fluids and multimodal ileus prevention); its 2025 surgeons' update by e-Delphi highly recommends medical optimisation and no bowel preparation, moderately recommends robotic cystectomy with intracorporeal diversion, and supports medical thromboprophylaxis, removing the nasogastric tube at the end of surgery, fluid restriction and opioid-sparing anaesthesia, with no consensus on epidurals and consensus against resection-site drains.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS cystectomy; enhanced recovery bladder cancer surgery; fast-track cystectomy; perioperative care for radical cystectomy

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Enhanced recovery after colorectal cancer surgery (ERAS pathway for bowel resection)](https://onco.cc/protocols/enhanced-recovery-after-colorectal-surgery/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Muscle-invasive and advanced bladder cancer](https://onco.cc/cancers/muscle-invasive-bladder-cancer/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)
- terms: [Prehabilitation (the pre-treatment window)](https://onco.cc/terms/prehabilitation-term/), [Radical cystectomy](https://onco.cc/terms/cystectomy/)
- ideas: [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/), [Four weeks of blood-clot prevention after major abdominal or pelvic cancer surgery](https://onco.cc/ideas/idea-pu-extended-clot-prevention-after-surgery/)

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