Selection and perioperative management of patients undergoing radical cystectomy and urinary reconstruction

In addition to appropriate laboratory and radiologic evaluation, a thorough history and physical examination is needed when considering radical cystectomy and/or perioperative chemotherapy for the management of invasive bladder cancer. Perioperative complications are expected in up to 60% or more of patients undergoing radical cystectomy due to patients’ advanced age, concurrent tobacco use, and the high-risk nature of the procedure. Thus, patient selection involves consideration of a patient's age, comorbid illnesses, functional status, and quality of life expectations. Comprehensive perioperative management strategies to decrease morbidity require a better understanding of frailty, pre-operative assessment, and care by a wide range of providers functioning as a team, use of evidence-based medicine to improve care pathways and robust post-operative care to identify potential problems early.