INTRODUCTION: The principles of enhanced recovery after surgery (ERAS) protocols have been developed to optimize care and facilitate recovery after major surgery. The purpose of this systematic review is to present an up-to-date assessment of the perioperative cares in complex urological surgery from the available evidence and ERAS group recommendations. MATERIALS AND METHODS: Systematic searches of PubMed, Embase, Cochrane library and conference abstracts and bibliographies databases. RESULTS: A total of six studies were identified that met the inclusion criteria. Two examined the role of ERAS in radical cystectomy, and the rest examined its role in renal surgery (open, laparoscopic or partial nephrectomy). These studies demonstrated a reduction in duration of inpatient stays with no increase in morbidity in ERAS groups compared with traditional care. CONCLUSIONS: ERAS protocols can reduce the length of hospital stay after major urological surgery, without increasing morbidity or mortality.