Cystectomy With Continent Cutaneous Urinary Diversion

WHAT YOU SHOULD KNOW:

• Cystectomy (sis-tek-tuh-me) with continent cutaneous urinary diversion (bypass) is surgery to remove your bladder. A new bladder or "reservoir" (reh-zih-vor) is made from a piece of your intestine. The ureters (tubes that go from the kidney to the bladder) are sewed into this new bladder. The end of the new bladder will come out of a hole in the skin on your abdomen. This is called a stoma.
  
  
• You may need this surgery if you have cancer of the bladder. This surgery may be able to cure the cancer. You may need this surgery after an accident or illness, such as one that caused you to become paralyzed. You will need to put a catheter (thin bendable tube) into the stoma around 5 times a day to drain the urine.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual or get an infection. Urine could leak where the ureters are connected to the section of intestine. Or, there could be a blockage in the ureters so urine cannot drain from the kidneys. Caregivers will watch you closely and work with you to fix these problems.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• But if you don't have surgery, your problem could get worse. If you have cancer and the bladder is not taken out, the cancer could spread and you could die. Call your caregiver if you have questions or concerns about your medicine or care.

WHILE YOU ARE HERE:

• Blood Transfusion:
  
  
  • You may need a blood transfusion if your blood count is low. This is called anemia. Or, you may need a blood transfusion if you lose a lot of blood during surgery. You may be able to donate your own blood before surgery. This is called autologous (ah-tall-uh-gus) blood donation. You can donate your own blood no later than 3 days before surgery. Or, you may also ask a family member or friend with the same blood type to donate his/hers. This is called directed blood donation.
    
    
  • Many people are worried about getting AIDS or hepatitis from a blood transfusion. The risk of this happening is rare. Usually the risk of not getting the blood is greater than getting AIDS or hepatitis. If your body doesn't have enough blood, you could have a heart attack or die.
  
  
• Call Button: You can use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call.
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Informed Consent:
  
  
  • You have the right to understand your health problem. In words you can understand, you should be told what tests, treatments, or procedures may be done to treat your problem. Your doctor should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that gives your doctor permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to you. Your doctor should tell you what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Tests: You may need one or more of the following tests. Some of these tests help caregivers find out what is causing your illness. Other tests are used to help caregivers plan your treatment.
  
  
  • Blood Tests: You may need blood taken for tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. It is tested to see how your body is handling your surgery. You may need to have blood drawn more than once.
    
    
  • Bone Scan: This is a test to look at your bones. You are given a small, safe amount of radioactive dye in an IV. Pictures are then taken of your bones. Caregivers can look at the pictures to see if the cancer has spread outside your bladder into the bones. These pictures can also show infections or cancer in the bones.
    
    
  • Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing before surgery. Caregivers may also use the x-ray to look for signs of infection like pneumonia (new-moan-yuh) or cancer.
    
    
  • CT Scan and Cystography: This test is also called a "CAT" scan. A special x-ray machine takes computer pictures of your bladder, kidneys and other areas of your body. Your caregivers look at the pictures to see if the cancer has spread someplace outside the bladder. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the body tissue and cancer show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
    
    
  • Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
    
    
  • IVP: This is also called an intravenous pyelogram. An IVP is an x-ray of the kidneys, bladder, and ureters (tubes that carry urine). Dye is put into your IV, which makes these organs show up better in x-ray pictures. You may need to have more than one x-ray over short periods of time during your IVP. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or other medicines.
    
    
  • 24 Hour Urine Test: All of the urine that you pass for 1 day is collected. Every time you urinate you put the urine into a jug. Caregivers measure and write down how much you urinate. The urine is put into a larger container that is kept cold. If you urinate during the night, save this urine also. At the end of 24 hours the urine is sent to a lab to be tested. This also helps caregivers know about how much urine your body makes each day. They use this information to decide how large they should make your new bladder.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • General Anesthesia (an-iss-thee-zuh):
    
    
    • This is medicine to make you comfortable during surgery. The medicine is given as a liquid in your IV. Or, it is given as a gas through a face mask. The medicine can also be given through a tube placed in your mouth and throat. This tube is called an endotracheal (end-o-tra-kee-ull) tube or "ET" tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up.
      
      
    • You are completely asleep during surgery. Ask your caregiver for the anesthesia CareNotes™ handout if you want to know more about anesthesia. Do not sign legal documents for 24 hours after having anesthesia because anesthesia medicine may make your thinking unclear.
    
    
  • Special tubes: Some tubes may be put into an artery or vein before, during, or after surgery. These will help caregivers watch how you are doing during or after surgery.
    
    
    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
      
      
    • CVP Line: A CVP line is also called a central line. It is an IV catheter (kath-uh-ter) put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen (belly) meets your upper leg. The head of your bed may be lowered to help the blood vessel fill up. This may make it easier to put in the catheter. The skin where the catheter will be placed is numbed so you won't feel much pain. The IV may be used to give medicines or to measure how your heart is doing before and after surgery.
    
    
  • Vital Signs:
    
    
    • This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope (steth-uh-skop).
      
      
    • Caregiver will also use a pulse oximeter (oks-ih-mih-ter) to measure how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• During Surgery: Caregivers clean your abdomen (belly) with soap and water. This soap may make your skin yellow, but is cleaned off later. Sheets are put over you to keep the surgery area clean. An incision (cut) is made in your abdomen and your bladder is removed. Lymph nodes in the area may also be removed. Lymph nodes are the glands in your body that can get swollen while fighting an infection.
  
  
  • The prostate (prah-stat) gland, seminal vesicles, and part of the ureters in men may also be removed. The prostate gland is a male sex gland that helps make semen. It wraps around the neck of the bladder. The seminal vesicles make fluid to help the sperm grow. In women the uterus (womb), cervix (opening of the uterus) and the top part of the vagina may also be removed.
    
    
  • A section of intestine is separated from the rest of the intestines and used to make a new bladder. The ureters are connected to this section of intestine. Two small hollow tubes called stents are put through the ureters into the kidney to drain urine while you heal after surgery.
    
    
  • One end of the section of intestine is brought outside through the skin of the abdomen. This is called a stoma. Or, another piece of tissue like the appendix may be used. The piece of tissue is connected the end of the new bladder to the skin near your umbilicus (belly button). Then the incision in your abdomen is closed with stitches (thread) or staples.
  
  
• After surgery: You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. An adult will need to drive you home and should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.
  
  
  • Activity:
    
    
    • You may need to rest in bed but caregivers will help you get out of bed, probably the first day of surgery. If you are not allowed out of bed, you can still exercise your legs in bed. Do this by lifting one leg off the bed and drawing big circles with your toes. Then do it with the other leg. Another good exercise is to lie on your side and pretend to pedal a bike. This makes your legs stronger and stops blood clots from forming. Stop if you become tired.
      
      
    • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
    
    
  • Prevent constipation: High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.
    
    
  • Deep Breathing and Coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (spit) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
    
    
    • Hold a pillow tightly against your abdomen (belly) when you cough. This can help lessen the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
      
      
    • You may be asked to use an incentive (in-sen-tiv) spirometer (sper-om-ih-ter). This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
    
    
  • Drains: These are thin rubber tubes put into your skin to drain blood and leaking urine from around your incision. The drain(s) are taken out when the incision stops draining.
    
    
  • Catheter (kath-uh-ter): You will have 2 tubes called catheters coming out of the stoma to drain the new bladder of urine and mucous. Two more very small tubes called stents will come out of the stoma to drain urine from the kidneys.
    
    
    • Don't pull on the catheter because this will make you hurt or bleed.
      
      
    • Don't kink the catheter because the urine cannot drain.
      
      
    • Don't lift the bag of urine above the catheter. If you do this, the urine will flow back into your new bladder. This can cause an infection.
    
    
  • Intake/Output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O."
    
    
    • When you are allowed, drink 6 to 8 (soda-pop can size) glasses of water each day. Or, follow your caregiver's advice if you must limit the amount of liquid you drink. If you are on I&O, tell your caregiver how much liquid you drink.
      
      
    • Ask your caregiver if it is OK to flush your urine down the toilet. It may need to be measured before it is thrown away.
    
    
  • Irrigation: Caregivers will irrigate the new bladder 2 to 3 times a day. This means that they will put salt water into the catheter in your stoma to clean out mucous. Mucous is a clear colored fluid.
    
    
  • Medicines:
    
    
    • Antibiotics(an-ti-bi-ah-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria (bak-teer-e-uh). Antibiotics may be given by IV, as a shot, or by mouth.
      
      
    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
      
      
    • Pain Medicine: Caregivers may give you medicine to take away or lessen your pain. This medicine may be given in your IV, as a shot, or by mouth. Tell caregivers if the pain does not go away or comes back.
      
      
    • Stool Softeners: You may be given stool softeners to keep you from getting constipated (kon-stih-pa-ted). Constipated means it is hard to have a BM. Stool softeners make your BM softer so you do not need to strain when having a BM.
    
    
  • Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
    
    
  • Stents: These are 2 very small tubes put into the ureters to drain the kidneys. They will be removed about a week or so after surgery.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.