The UroOnc Minute: Prehabilitation for Cystectomy, with Nikita R. Bhatt, MBBS, MCh, MMed, FRCS

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, continues coverage from the 41st Annual European Association of Urology Congress in London, United Kingdom, spotlighting an emerging and increasingly important area in perioperative care: prehabilitation. Joined by Nikita R. Bhatt, MBBS, MCh, MMed, FRCS, a urologist at St Vincent’s University Hospital in Dublin, Ireland, the conversation shifts the traditional surgical focus upstream, toward optimizing patients before they ever enter the operating room. With complication rates following cystectomy remaining substantial, Bhatt underscores the need to rethink how clinicians prepare patients for complex procedures.

Drawing from her clinical experience treating both benign and malignant bladder conditions, Bhatt highlights a key observation: many patients, particularly those undergoing cystectomy for benign indications, present in a markedly deconditioned state. This insight helped drive her interest in prehabilitation—an approach aimed at improving physical, nutritional, and psychological readiness prior to surgery. While existing research has largely focused on physical activity, Bhatt advocates for a more comprehensive, multimodal strategy that also addresses mental health, smoking cessation, sleep, and diet, all of which may influence postoperative recovery.

A central theme of the discussion is feasibility. As Bhatt explains, delivering a truly multidisciplinary prehabilitation program within the confines of a hospital system can be resource-intensive and logistically challenging. To address this, she is developing a digitally delivered prehabilitation model in collaboration with colleagues at University College Dublin. This platform connects patients with a team of health professionals including physiotherapists, nutritionists, and mental health specialists who guide them through individualized interventions in the weeks leading up to surgery. Although digital prehabilitation remains relatively underexplored in urology, Bhatt notes that early studies in bladder and prostate cancer suggest a growing interest in this approach.

The episode also delves into the ongoing challenge of defining meaningful clinical end points in prehabilitation research. Traditional metrics such as length of stay, morbidity, and mortality have not consistently demonstrated improvement in cystectomy populations, prompting investigators to consider alternative measures. Bhatt discusses the limitations of functional outcomes alone and emphasizes the potential value of patient-reported outcomes, such as quality of recovery and return to baseline activity. As part of her planned trial, she aims to incorporate validated instruments to better capture the patient experience, which is an area she believes is both underrepresented and highly relevant.

Looking ahead, Bhatt points to several ongoing trials that may help clarify the role of prehabilitation in urologic oncology, including the ENHANCE trial (NCT05480735) in Europe¹ and the Get Moving trial led by Sarah P. Psutka, MD, MS, in the United States (NCT06040762).² As these data mature and as digital platforms continue to evolve, prehabilitation may become an integral component of surgical care pathways. For now, this episode offers a forward-looking perspective on how proactive, patient-centered interventions could reshape outcomes for individuals undergoing major urologic surgery.

REFERENCES

1. Akdemir E, Sweegers MG, Vrieling A, et al. EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial. BMJ Open. 2023;13(3):e071304. doi:10.1136/bmjopen-2022-071304

2. A Home-Based Prehabilitation Exercise Intervention for Improving Physical Function in Patients With Bladder Cancer and Upper Tract Urothelial Cancer, Get Moving Trial. ClinicalTrials.gov. Last updated March 2, 2026. Accessed March 19, 2026. https://clinicaltrials.gov/study/NCT06040762