Enhanced recovery after surgery in pediatric urology: Current evidence and future practice

Purpose To offer an up-to-date appraisal of the current sta-tus of enhanced recovery after surgery (ERAS) pro-tocols in pediatric urology and to provide a guide for the clinical urologist.Materials and methods We performed a comprehensive literature search and scoping review on ERAS protocols in pediatric urology using Pubmed (from 1946), Cochrane library, and MEDLINE to December 2021 with the terms "enhanced recovery", "protocolised care", "post-operative protocol", "fast-track surgery"and "pe-diatric urology". Studies were excluded if they did not include perioperative intervention related to urological procedures, no full-text available and in non-English language.Results To date, eight clinical studies (involving 1153 pa-tients) have been published on ERAS protocols in pediatric urology. The patients involved ranged from neonates to adolescents, and the urological procedures included bladder augmentation, the Mitrofanoff procedure, laparoscopic pyeloplasty, laparoscopic nephrectomy, hypospadias repair, etc. Multidisciplinary components such as surgical and anesthetic considerations have been employed in ERAS protocols. The length of hospital stay was significantly lower in the ERAS groups with earlier enteral feeding resumption and return of bowel function in pediatric urology patients. The imple-mentation of ERAS protocols does not result in higher complication and readmission rates; instead, some studies have even demonstrated a significant reduction in complication occurrence. Conclusion ERAS is novel to pediatric urology with a limited scale of published data in the literature. Initial clinical studies revealed that ERAS appears to be efficacious in the field of pediatric urology. Further prospective studies formulating a standardized multimodal protocol are encouraged to better un-derstand key components of ERAS and incorporate ERAS into clinical practice to optimize surgical out-comes for pediatric urology procedures.