Cystectomy With Ileal Conduit

WHAT YOU SHOULD KNOW:

• A cystectomy is surgery to remove your bladder. Your bladder is the organ that holds the urine in your body before you urinate. Normally, your urine passes from your kidneys into your bladder through tubes called ureters. Your urine then moves out of your bladder through a tube called your urethra. After your bladder is removed, your ureters are connected to a piece of your bowel. This creates a passageway called an ileal conduit. The ileal conduit will drain your urine from your ureters to a hole in your abdomen. This hole is called a stoma and is attached to a bag that collects your urine.
  
  
• You may need a cystectomy if you have bladder cancer or very bad damage to your bladder. During your cystectomy, your caregiver may remove other organs near your bladder. Your caregiver may need to remove your lymph nodes. Your lymph nodes are lumps of tissue that fight infection caused by germs called bacteria. After surgery, your urine will only leave your body through the stoma. A cystectomy may decrease your pain and make it easier for urine to leave your body. If you have cancer, a cystectomy may help your caregiver plan your treatment. A cystectomy may also help stop your cancer from spreading to other parts of your body.

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:

• After surgery, you may feel confused or sick to your stomach. Your abdomen may be swollen or painful. The skin around your stoma or wound (surgery cut) may become red or infected. An organ in your abdomen may push through your stoma. You may get an infection or small stones in your ureters. Your ureters or conduit may become blocked and urine may not be able to exit your body. Your bowels may stop working and you may not be able to have a BM.
  
  
• 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. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• You may bleed more than expected and need a blood transfusion. Your bowel may leak inside your abdomen and cause a serious infection. Your lungs may become infected or stop working properly. You may have a heart attack and you may die. Even with surgery, you may still have cancer. Without surgery, your bladder problems may get worse. If you have cancer, it may spread and you may die. Call your caregiver if you have questions or concerns about your condition, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Pre-op care: You will be taken to the room where you will have surgery and moved to a special table. Your skin will be cleaned and sheets will be put over you to keep your surgery area clean.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• 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.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

During your surgery:

• Your caregiver makes a cut on your lower abdomen from your groin to above your belly button. Your caregiver may make the cut up to the bottom of your chest if needed. Your blood vessels are tied to stop bleeding. If you have cancer, he checks if it has spread to other organs, such as your liver. Your caregiver removes your bladder and usually removes nearby lymph nodes. If you are male, your caregiver usually removes your prostate gland, which wraps around your urethra. If you are female, your caregiver may remove your uterus, ovaries, or other reproductive organs. Your caregiver may also remove other organs that have cancer in them.
  
  
• After your bladder is removed, your caregiver cuts off a small part of your bowel. Your ureters are connected to this piece of bowel to create a conduit. Your caregiver repairs the remaining bowel using thread. Your caregiver makes a cut in your abdomen to make the stoma. The conduit is then attached to the stoma so that urine may exit your body. Your urine empties into a bag attached to your stoma. Your caregiver closes your cuts with stitches and staples. Your bladder, lymph, or other removed organs may be sent to a lab for testing.

After your surgery:

You will be taken to a room where you can rest until you are awake. Your caregiver will make sure that urine drains properly through your stoma. Your caregiver will decide when it is OK for you to be taken to your hospital room. Do not get out of bed until your caregiver says it is OK. You may need to continue wearing compression stockings to prevent blood clots from forming. Your caregiver will decide when it is OK to remove your nasogastric tube.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after.
  
  
• Breathing: You may be taught how to cough or breathe deeply to prevent lung problems after your surgery. You may also need to use a tool called an incentive spirometer. An incentive spirometer is used to measure how much air can go into your lungs. Ask your caregiver for more information about using an incentive spirometer.
  
  
• TPN: TPN stands for total parenteral nutrition. It is also called hyperalimentation. It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when you have problems with eating or digesting food. TPN is usually put into your body through a large IV catheter, such as a central line. You may need TPN for several days or longer.
  
  
• Gum chewing: You may be asked to chew gum every few hours after your surgery. This may help your bowels start working.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
    
    • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.
      
      
    • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.