Mechanical and antibiotic bowel preparation for urinary diversion surgery

Purpose: We reviewed the existing scientific literature regarding the efficacy of preoperative mechanical and antibiotic bowel preparation for urinary diversion surgery. Materials and Methods: We performed MEDLINE searches of the literature from 1966 through 2000 and obtained additional references through a review of the bibliographies of select articles. Results: For urinary diversion surgery information regarding appropriate mechanical and antibiotic bowel preparation is scant. The colorectal surgery literature indicates that oral sodium phosphate appears to be better tolerated than polyethylene glycol and is as effective, although the latter is preferred in patients with compromised renal, cardiac or liver function. A combination of oral and parenteral antibiotics should be used for all urinary reconstructive surgeries involving gastrointestinal tract segments. A parenteral second generation cephalosporin antibiotic should be given within 1 hour of skin incision and repeated at an interval of twice the antibiotic serum half-life or when blood loss exceeds 1 l. Conclusions: For urinary diversion surgery contemporary methods of mechanical and antibiotic bowel preparation appear to be safe, effective and better tolerated than traditional bowel preparation methods.