Research at Roswell Park is improving recovery for bladder cancer patients and may transform post-surgical care.
About 25% of U.S. patients with invasive bladder cancer undergo radical cystectomy, or bladder removal. Most are in their 70s and have additional health conditions such as high blood pressure, diabetes, or heart disease. Recovery can be difficult, and up to 39% develop urinary tract infections (UTIs) within 90 days of surgery. UTIs can cause fever, chills, nausea, and painful urination, and in severe cases may lead to kidney damage, sepsis, or altered mental status.
Khurshid Guru, MD, Chair of Urology and Director of Robotic Surgery at Roswell Park, notes that infections are the leading cause of post-surgical complications and hospital readmissions. Dr. Guru has performed more than 800 robot-assisted cystectomies, and nearly 900 have been performed at Roswell Park.
Evaluating Antibiotics for Prevention
While antibiotics could prevent post-surgical infections, their safety and effectiveness must be proven through clinical trials. To provide Level 1 evidence, Dr. Guru and his team conducted a randomized controlled trial with 77 patients undergoing robot-assisted radical cystectomy. Forty patients received standard care, and 37 also received antibiotics for 30 days after discharge.
The results were striking. UTIs developed in 10 patients in the standard care group, compared with none in the antibiotics group. The difference was statistically significant. Ahmed Aly Hussein Aly, MD, Associate Professor of Oncology and Surgery at Roswell Park, was first author of the study, published in the Journal of Urology. Two editorials praised the findings, noting that they represent the highest-quality evidence on the topic and are likely to change urologic oncology practices.
Roswell Park now provides antibiotics to all cystectomy patients after discharge, and the approach is expected to spread to other centers.
Reducing Infections Lowers Costs and Social Burdens
Dr. Guru emphasizes that the benefits go beyond physical health. Older adults often lack reliable transportation or caregivers, and infections can significantly impact their daily lives.
The study also showed a sharp reduction in hospital readmissions and costs. Within 90 days, 30% of patients who did not take antibiotics were readmitted due to infection, compared with just 5% in the antibiotics group. Readmissions added a median cost of over $9,000 per patient.
“We can reduce infection risk and improve recovery by providing antibiotics after surgery,” Dr. Guru concludes.
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