A Preliminary Investigation: Alvimopan Use to Prevent Post-Operative Ileus after Radical Cystectomy with Urinary Diversion


Background: Postoperative ileus (POI) is a common and frustrating patient complication after a urinary diversion by using a segment of bowel. Alvimopan is an oral selective antagonist to the peripheral μ-opioid receptor. Our study investigates the effect of alvimopan on POI in patients undergoing radical cystectomy. There are no documented studies on alvimopan’s efficacy in urologic surgery literature. Methods: Approval from the Institutional Review Board was obtained to conduct a retrospective review of patients’ records from August 2009 until August 2011. The study included sixteen patients who had undergone radical cystectomy with ileal diversion. Exclusion criteria included patients with chronic opioid use, previous colostomy or ileostomy, or significant comorbidities which could cause increased postoperative complications. Statistical analysis was performed to examine the association of alvimopan use with decreased time to dietary advancement and decreased length of hospital stay. Results: The alvimopan group advanced their diet more than 24 hours earlier in comparison with the alvimopan naive group (P < 0.0433), and the alvimopan group had a greater had a greater or 26% shorter hospital length (P < 0.0451) than one day. We showed a reduced risk of POI and subsequent decreased hospital course length. There was no significant difference in readmission rate or need for nasogastric tube (NGT). Interpretation: To our knowledge we report one of the first uses of alvimopan in reducing POI in the urological surgery literature. Our novel experience with using this drug is encouraging. Further research will ultimately determine if standard use of alvimopan to decrease POI in radical cystectomy with ileal diversion will be implemented.

Share and Cite:

B. Katz, G. Gaunay, B. Tareen and E. Goluboff, "A Preliminary Investigation: Alvimopan Use to Prevent Post-Operative Ileus after Radical Cystectomy with Urinary Diversion," Open Journal of Urology, Vol. 3 No. 7, 2013, pp. 272-275. doi: 10.4236/oju.2013.37051.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu and M. J. Thun, “Cancer Statistics, 2009,” CA: A Cancer Journal for Clinicians, Vol. 59, No. 4, 2009, pp. 225-249. http://dx.doi.org/10.3322/caac.20006
[2] M. Maffezzini, F. Campodonico, G. Canepa, et al., “Current Perioperative Management of Radical Cystectomy with Intestinal Urinary Reconstruction for Muscle-Invasive Bladder Cancer and Reduction of the Incidence of Postoperative Ileus,” Surgical Oncology, Vol. 17, No. 1, 2008, pp. 41-48. http://dx.doi.org/10.1016/j.suronc.2007.09.003
[3] E. K. Tan, J. Cornish, A. W. Darzi and P. P. Tekkis, “Meta-Analysis: Alvimopan vs. Placebo in the Treatment of Post-operative Ileus,” Alimentary Pharmacology & Therapeutics, Vol. 25, No. 1, 2006, pp. 47-57.
[4] T. Herzog, R. Coleman, J. Guerrieri, et al., “A Doubleblind, Randomized, Placebo-Controlled Phase III Study of the Safety of Alvimopan in Patients Who Undergo Simple Total Abdominal Hysterectomy,” American Journal of Obstetrics & Gynecology, Vol. 195, No. 2, 2006, pp. 445-453. http://dx.doi.org/ 10.1016/j.ajog.2006.01.039
[5] T. Bell, S. Poston, M. Kraft, et al., “Economic Analysis of Alvimopan in North American Phase III Efficacy Trials,” American Journal of Health-System Pharmacy, Vol. 66, No. 15, 2009, pp. 1362-1368. http://dx.doi.org/10.2146/ajhp080329
[6] J. Schmidt, B. Stoffels, A. Nazir, et al., “Alvimopan and COX-2 Inhibition Reverse Opioid and Inflammatory Components for Postoperative Ileus,” Neurogastroenterology & Motility, Vol. 20, No. 6, 2008, pp. 689-699. http://dx.doi.org/10.1111/j.1365-2982.2007.01078.x
[7] C. Delaney, U. Yasothan and P. Kirkpartrick, “Alvimopan,” Nature Reviews: Drug Discovery, Vol. 7, No. , 2008, pp. 727-728. http://dx.doi.org/10.1038/nrd2668
[8] H. Bream-Rouwenhorst and M. Cantrell, “Alvimopan for Postoperative Ileus,” American Journal of Health-System Pharmacy, Vol. 66, No. 14, 2009, pp. 1267-1277. http://dx.doi.org/10.2146/ajhp 080445
[9] B. Wolff, J. Weese, K. Ludwig, et al., “Postoperative Ileus-Related Morbidity Profile in Patients Treated with Alvimopan after Bowel Resection,” Journal of the American College of Surgeons, Vol. 204, No. 4, 2007, pp. 609-616. http://dx.doi.org/10.1016/j.jamcollsurg.2007.01.041
[10] I. Obokhare, B. Champagne, S. Stein, et al., “The Effect of Alvimopan on Recovery after Laparoscopic Segmental Colectomy,” Diseases of the Colon & Rectum, Vol. 54, No. 6, 2011, pp. 743-746. http://dx.doi.org/10.1007/DCR.0b013e318217ed17
[11] A. Lightfoot, M. Eno, K. Kreder, et al., “Treatment of Postoperative Ileus after Bowel Surgery with Low-Dose Intravenous Erythromycin,” Journal of Urology, 2007, Vol. 69, No. 4, 2007, pp. 611-615. http://dx.doi.org/10.1016/j.urology.2006.12.027
[12] H. Park, C. Kwak, S. Byun, et al., “Early Removal of Nasogastric Tube after Cystectomy with Urinary Diversion: Does Postoperative Ileus Risk Increase?” Journal of Urology, Vol. 65, No. 5, 2004, pp. 905-908.
[13] E. Kouba, E. Wallen and S. Pruthi, “Gum Chewing Stimulates Bowel Motility in Patients Undergiong Radical Cystec-Tomy with Urinary Diversion,” Journal of Urology, Vol. 70, No. 6, 2007, pp. 1053-1056. http://dx.doi.org/10.1016/j.urology.2007.07.048
[14] H. Choi, S. Kang, D. Yoon, et al., “Chewing Gum Has a Stimulatory Effect on Bowel Motility in Patients after Open or Robotic Radical Cystectomy for Bladder Cancer: A Prosperctive Randomized Comparative Study,” Journal of Urology, Vol. 77, No. 4, 2011, pp. 884-890. http://dx.doi.org/ 10.1016/j.urology.2010.06.042
[15] R. Svatek, M. Fisher, M. Williams, et al., “Age and Body Mass Index Are Independent Risk Factors for the Development of Postoperative Paralytic Ileus after Radical Cystectomy,” Journal of Urology, Vol. 76, No. 6, 2010, pp. 1419-1424.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.