the New England Section of the American Urological Association
Search Meeting Site Only
Annual Meeting Home
Past & Future Meetings: NEAUA

Back to 2011 Program

Accelerated Gastrointestinal Recovery with Use of Alvimopan after Radical Cystectomy with Urinary Diversion
Anup A Vora1, Andrew Harbin1, Robert Rayson1, Keith Christiansen1, Reza Ghasemian2, Jonathan Hwang1, Mohan Verghese1
1Georgetown University, Washington, DC;2Washington Hospital Center, Washington, DC

Radical cystectomy, while being the gold standard treatment for muscle-invasive cancer, is associated with significant morbidity, with rates of gastrointestinal complications being reported as high as 20%. Alvimopan is a peripherally-acting, mu-opioid receptor antagonist that has been shown in randomized-control trials to accelerate gastrointestinal recovery in patients undergoing bowel resection with primary anastamosis. We report our experience with gastrointestinal recovery for patients undergoing cystectomy with urinary diversion treated with alvimopan.
Materials & Methods:
From 1/2008 to 3/2011, 41 consecutive patients underwent radical cystectomy with urinary diversion performed by a single surgeon. The first 25 patients in our study did not receive alvimopan and were kept with nasogastric-decompression until return of flatus. The latter 16 patients received perioperative alvimopan and were without postoperative nasogastric-decompression.
Time to first flatus (3.2 vs 5.6 days,p=<0.01) and bowel movement (3.7 vs 6.0 days,p=<0.01) were significantly shorter in those patients who received alvimopan. Additionally, initiation of clear liquid (4.2 vs 6.3 days) and regular diet (5.9 vs 7.3 days p=<0.01) were accelerated in the alvimopan cohort. There were no incidences of prolonged ileus in those patients who received perioperative alvimopan (0% vs 24%,p=0.03).

Urinary diversion status post radical cystectomy is associated with significant gastrointestinal morbidity. In our experience, the use of alvimopan perioperatively significantly accelerates the rate of GI recovery and reduces the incidence of post-operative ileus.

Pre- & Postoperative Comparison Between Patients With & Without Alvimopan.
Without AlvimopamWith Alvimopanp-value
Length of Hospital Stay (days)
Length of Nasogastric Decompression (days)5.50<0.01
Time to First Flatus (days)5.63.16<0.01
Time to First Bowel Movement (days)6.03.6<0.01
Time to Initiation of Clear Liquid Diet (days)6.34.2<0.01
Time to Initiation of Regular Diet (days)
Incidence of Prolonged Postoperative Ileus24%0%0.03

Back to 2011 Program


© 2024 New England Section of the American Urological Association. All Rights Reserved. Privacy Policy.