In Europe, bladder cancer (BC) is the 6th most common tumor entity. Globally, over
540,000 new cases have been reported annually in recent years. Approximately 75% of cases
are diagnosed as non-muscle-invasive BC at initial presentation, which can generally be
treated in a bladder-preserving manner through transurethral resection and intravesical
therapy. In cases of muscle-invasive, non-metastatic BC, guidelines recommend radical
cystectomy (RC) with neoadjuvant chemotherapy in a curative setting, provided the patient
is suitable for such treatment. Considering comorbidities, mortality, and quality of
life, various forms of urinary diversion are employed during RC. These include
incontinent diversions, such as ileal or colonic conduits, and continent diversions, such
as orthotopic bladder replacement using the ileum (neobladder).
A direct comparison of these different urinary diversion methods is currently challenging
due to a lack of data. RC is associated with one of the highest complication rates among
urological procedures. Rehabilitation following RC must focus on addressing postoperative
functional impairments, restoring physical and mental performance, and facilitating a
prompt return to social and professional life. The ERAS (Enhanced Recovery After Surgery)
concept, originally established in colorectal surgery, has also demonstrated reduced
overall hospital stays in RC without increasing complication rates. While it remains
uncertain whether the ERAS concept improves prognosis and morbidity, it is considered
safe, as no studies have reported an increase in severe complications or mortality
associated with its implementation.
Studies in visceral surgery involving prehabilitation for patients with colorectal,
esophageal, and lung cancers have shown functional benefits, such as improved fitness,
mobility, and strength, but without reductions in complication rates or mortality. In a
randomized controlled trial, Minella EM et al. demonstrated the effectiveness of
prehabilitation in improving functional outcomes, such as strength and endurance, in BC
patients undergoing RC. However, no significant differences in postoperative
complications or mortality were observed. A recent prospective study involving patients
prior to RC also reported significant improvements in strength and functional fitness.
In the prospective randomized study presented here for evaluation, the investigators aim
to investigate the impact of preoperative physical activity on perioperative morbidity
(primary endpoint). Secondary endpoints include quality of life, length of hospital stay,
mortality, and postoperative physical activity. The intervention group will undergo
preoperative preparation over four weeks, targeting a daily step count of 8,000-10,000.
Step counts will be self-monitored by patients using pedometers. Physical activity and
quality of life will be assessed at specific time points using established fitness
assessments and questionnaires. Comparative follow-ups will take place four weeks before
surgery, the day before surgery, one week postoperatively, and at three and twelve months
postoperatively.
The study will be conducted as a single-center trial at the Department of Urology at the
University of Munich over a three-year period.