DOI: https://doi.org/10.36347/sasjs.2026.v12i04.012

Pages: 312-316

Background: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer but is associated with high perioperative morbidity, affecting 50–65% of patients. This patient population is frequently characterized by advanced age, frailty, and malnutrition, which are further exacerbated by neoadjuvant chemotherapy (NAC). Prehabilitation has emerged as a multidisciplinary strategy to enhance physiological and psychological resilience before surgery. Objectives: This mini-review synthesizes current evidence regarding the components, clinical efficacy, and implementation challenges of prehabilitation programs in the RC population. Methods: We reviewed recent clinical trials, meta-analyses, and systematic reviews focusing on multimodal interventions—incorporating exercise, nutritional optimization, and psychological support—delivered during the preoperative window. Results: Multimodal programs consistently demonstrate improvements in functional capacity and health-related quality of life. Exercise interventions significantly enhance cardiorespiratory fitness and muscular strength, while preoperative immunonutrition has been shown to reduce surgical site infections and accelerate gastrointestinal recovery. Despite these functional gains, the impact on "hard" surgical outcomes remains inconclusive; while broader surgical oncology data suggest a reduction in overall complications, specific urologic meta-analyses have yet to definitively prove a reduction in length of stay or mortality. Implementation & Future Directions: While prehabilitation is safe and feasible with high adherence rates (80–100%), institutional barriers such as funding and time constraints remain. Current research, including the ENHANCE and INCyst trials, is focused on standardizing protocols and evaluating the role of digital health and home-based interventions. Conclusions: Prehabilitation is a promising strategy to optimize RC candidates. Although evidence for improved traditional su