LAUSR

To the Editor: We congratulate the authors for this successful prospective randomized trial and would like to make some suggestions. The authors state that an oral nutrition supplement (ONS), which was started before radical cystectomy (RC) and continued for 2 months, decreased the prevalence of sarcopenia. Although there was no statistical significance, major and overall complication rates were lower in the group receiving ONS. In addition, the readmission rate is reported as lower in this group. The authors also state that both groups were similar in terms of preoperative baseline data (age, gender, comorbidities, histopathology, etc). However, they did not specify any data on the type of urinary diversion (UD) performed after radical cystectomy and the distribution among the groups. To our knowledge UD performed after radical cystectomy is the major cause of short and long-term complications regardless of intestinal segment used or type of diversion. In a large retrospective study Shimko et al demonstrated that UD related complications accounted for almost 60% of complications after RC (mean 2.3 complications per patient). Postoperative ileus is one of the most common minor complications after radical cystectomy and urinary diversion, and can affect the timing of enteral feeding. Postoperative ileus is also directly related to diversion type. We would like to ask to the authors whether the timing of enteral feeding was similar between groups. Respectfully,