Patients undergoing urinary diversion are at high risk for complications in the perioperative period. The exact cause of these complications remains poorly defined but is likely multifactorial. Current efforts to optimize patients in the perioperative period, including prehabilitation, smoking cessation, recognition and treatment of comorbid conditions and malnutrition, immunonutrition supplementation, carbohydrate loading, and prevention of known complications and implementation of enhanced recovery after surgery pathways, seem beneficial in helping to improve outcomes in this at-risk population. Further studies (some of which are ongoing) are necessary to help optimize these strategies and identify which modifiable factors have the greatest impact.