Radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard treatment for patients diagnosed with localized muscle-invasive bladder cancer. Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway comprising recommendations on different items with variable evidence that are aimed at improving outcomes. This review provides an overview of the application of specific elements of the ERAS guidelines. Forty-eight series were identified through our literature search. The studies reported a median of 16 out of the 22 ERAS steps (72.7%). The elements were applied in 79.3% of cases (interquartile range 61.1-85%) if mentioned in the studies, decreasing to 73.5% in the postoperative period. PATIENT SUMMARY: Guidelines on enhanced recovery after surgery recommend steps to follow and cover all areas of the patient's journey through the surgical process. We looked at the application of the elements for patients with bladder cancer. We found inconsistent reporting and use.

Department of Maternal Infant and Urological Sciences Sapienza Rome University Policlinico Umberto 1 Hospital Rome Italy

Department of Physiology and Biophysics Weill Cornell Medicine New York NY 10065 USA; Institute for Computational Biomedicine Weill Cornell Medicine New York NY 10021 USA; Meyer Cancer Center Weill Cornell Medicine New York NY 10065 USA

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Department of Urology Changhai Hospital Naval Medical University Shanghai China

Department of Urology The Ohio State University Columbus OH USA

Department of Urology University Clinics of Brussels Hôpital Erasme Université Libre de Bruxelles Brussels Belgium; Department of Urology Institut Jules Bordet Université Libre de Bruxelles Brussels Belgium

Department of Urology University Hospital of Lausanne Switzerland

Department of Urology University of Vienna Vienna Austria

Department of Urology University of Vienna Vienna Austria; Department of Physiology and Biophysics Weill Cornell Medicine New York NY 10065 USA; Karl Landsteiner Institute of Urology and Andrology Vienna Austria; Department of Urology University of Texas Southwestern Dallas TX USA; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; European Association of Urology Research Foundation Arnhem The Netherlands

Division of Urology Department of Surgical Sciences San Giovanni Battista Hospital University of Studies of Torino Turin Italy

Division of Urology European Institute of Oncology Milan Italy

Oncologic Minimally Invasive Urology and Andrology Unit Department of Experimental and Clinical Medicine Careggi Hospital University of Florence Florence Italy

Urology Predictive Onco Urology AP HP Urology Hôpital Pitié Salpêtrière Sorbonne Université Paris France

USC Institute of Urology and Catherine and Joseph Aresty Department of Urology Keck School of Medicine University of Southern California Los Angeles CA USA

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