ERAS 2025: ERAS® in Urology: A Local Perspective
ERAS in Urology: A Local Perspective from Piemonte
Enhanced Recovery After Surgery (ERAS) has transformed perioperative care across multiple specialties by standardizing evidence-based, multimodal protocols that minimize surgical stress, optimize recovery, and improve outcomes. While ERAS is now well established in colorectal and gynecological surgery, its adoption in urology remains heterogeneous, particularly outside of high-volume centers.
At Cardinal Masai Hospital in Asti, a medium-to-high volume urologic center, ERAS implementation highlights both opportunities and challenges. Core elements span the perioperative continuum: preoperative education, nutritional optimization, cessation of smoking and alcohol, shortened fasting intervals, selective antibiotic and thromboembolic prophylaxis; intraoperative measures such as multimodal anesthesia, goal-directed fluid therapy, normothermia, and minimally invasive approaches; and postoperative priorities including early mobilization and oral intake, multimodal pain and antiemetic regimens, glycemic control, and prompt removal of drains and catheters. Together, these steps aim to reduce complications, length of stay, and costs, while improving functional recovery and patient satisfaction.
In Piemonte, regional collaboration has advanced these efforts through the EasyNet project, which builds on earlier successes in colorectal and gynecological surgery. EasyNet focuses on radical cystectomy for muscle-invasive bladder cancer, with three primary objectives: ensuring multidisciplinary preoperative evaluation, securing access to neoadjuvant chemotherapy, and embedding ERAS protocols into practice. Using a pre-post study design, the initiative compared cystectomies performed between May–December 2022 with those from January–April 2024. Early results mirror prior experiences: adherence to ERAS recommendations increased by nearly 30%, underscoring the feasibility and impact of structured, collaborative implementation.
The Piemonte experience demonstrates that even outside major referral hubs, ERAS can be successfully integrated into urologic oncology with tangible benefits for patients and systems. Sustained education, resource allocation, and multidisciplinary engagement remain critical to overcoming barriers and achieving widespread adoption in Italian urology.
Presented by: Vittorio Canale, Ospedale University, Asti, Italy
Written by: Stephen B. Williams, MD, MBA, MS, FACS, FACHE @SWilliams_MD on Twitter during the 11th Enhanced Recovery After Surgery (ERAS®) World Congress, September 17-19, 2025, Turin, Italy