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.

Getting Ready

Before your surgery:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need to take an antibiotic medicine before your surgery. This medicine helps kill bacteria that may cause an infection.
  
  
• Your caregiver will ask about your current and past health. He will ask if you have had any surgeries. Tell your caregiver if you have any bleeding problems or problems with your heart or lungs. Tell your caregiver if you smoke.
  
  
• You may meet with a special caregiver to talk about your stoma. This caregiver may teach you how to take care of your stoma after surgery. Together you may decide the best place in your stomach for your stoma. Often, your stoma will be placed in the lower part of your abdomen.
  
  
• Your caregiver may ask you to stop taking certain medicines before your surgery. Do not stop taking any medicines unless your caregiver tells you to stop. Always follow your caregiver's instructions on how to take your medicine.
  
  
• You may need to have tests done on your blood and urine. You may have imaging tests such as an x-ray or a computed tomography (CT) scan. You may also need a heart test, such as a an electrocardiogram (ECG). Your caregiver may check how well your lungs work. Your caregiver may need to look inside your bowel with a small camera. Ask your caregiver for more information about tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• You may need to have an enema to empty and clean out your bowel before surgery. During this procedure, liquid is put into your rectum through a tube. This liquid helps you have a bowel movement.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• 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. Your caregiver will make a cut on your lower abdomen from your groin to above your belly button. If you have cancer, he will check if it has spread to other organs, such as your liver. Your caregiver will remove your bladder and will usually remove nearby lymph nodes. Your caregiver may also remove other organs that have cancer in them. If you are male, your caregiver will usually remove your prostate gland, which wraps around your urethra. If you are female, your caregiver may remove your uterus, ovaries, or other reproductive organs.
  
  
• After your bladder is removed, your caregiver will cut off a small part of your bowel. Your ureters will be connected to this piece of bowel to create a conduit. Your caregiver will make a cut in your abdomen to make the stoma. He will then attach the conduit to the stoma so that urine may exit your body. Your urine will empty into a bag attached to your stoma. This bag will have marks on it so that you and your caregiver may measure your urine. Your caregiver will close 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 decide when it is OK for you to be taken to your hospital room. Do not try to get out of bed until your caregiver says it is OK. A caregiver may help you start walking. This may help your bowels work better.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You have trouble urinating.
  
  
• You have a fever (high body temperature).
  
  
• You get sick with a cold or the flu.

Seek Care Immediately if

• You cannot urinate at all.
  
  

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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.