Laparoscopic Cystectomy With Ileal Conduit

WHAT YOU SHOULD KNOW:

Laparoscopic Cystectomy With Ileal Conduit (Inpatient Care) Care Guide

  • A cystectomy is a 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. You may need a cystectomy if your bladder does not work. You also may need a cystectomy if your bladder or kidneys are damaged. In a laparoscopic cystectomy, small incisions (cuts) are made in your abdomen. Caregivers will put tools and a scope with a camera on it through these cuts to remove your bladder.

  • After your bladder is removed, your ureters are connected to a piece of your bowel. This creates a passage called an ileal conduit. This passage drains your urine out of your body through a hole in your abdomen. This hole is called a stoma and is attached to a bag that collects your urine. With an ileal conduit, urine may leave your body even when your bladder is not working. An ileal conduit may help prevent damage to your kidneys. If you have cancer, a cystectomy may help treat it and decrease the risk of it 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:

  • Your caregiver may switch to an open surgery and make a large cut on your abdomen. After surgery, your abdomen may be swollen or painful. You may feel more tired than usual, lose your appetite, and lose weight. The skin around your stoma or wound (surgery cut) may become red, infected, or pull apart. Your stoma may leak urine. You may have an organ in your abdomen push through your stoma. You may get an infection or small stones in your ureters or kidneys. Your ureters, conduit, or bowels may become blocked, which may stop you from urinating or having a BM.

  • 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, you may have trouble breathing, and you may have a heart attack. You may die from some of these problems. You may get a blood clot in your leg. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot may 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.

  • Without surgery, your bladder problems may get worse. If you have cancer, it may spread to other parts of your body. Call your caregiver if you have questions or concerns about your cystectomy, 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 help prevent blood clots. 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.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a 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.

  • Pre-op care: You will be taken to the room where you will have surgery and be moved to a table. Your skin will be cleaned and sheets will be put over you to keep your surgery area clean.

During your surgery:

  • Your caregiver makes small incisions on your abdomen for the scope and other surgery tools. Your caregiver uses these tools to remove your bladder. The lymph nodes near your bladder may be removed. Your lymph nodes are lumps of tissue that help fight infection. If you are male, your caregiver may remove your prostate, a gland that wraps around your urethra. If you are female, your caregiver may remove your uterus, ovaries, or other reproductive organs. A woman's reproductive organs are the parts of her body that help her conceive a baby. Your caregiver may use a machine to do your surgery, which he controls from a computer.

  • 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 the ileal conduit. Your caregiver makes an opening in your abdomen for the stoma. The conduit is attached to the stoma and stitches are used to reconnect your bowels. A bag is attached to your stoma to collect your urine. Your caregiver may put drains (tubes) in your abdomen to remove extra fluid from the surgery area. Your caregiver closes your cuts with stitches and staples. Your bladder, lymph nodes, and other removed organs are 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 okay for you to be taken to your hospital room. Do not try to get out of bed until your caregiver says it is okay. A caregiver may help you start walking. Your caregivers will measure the urine in your collection bag and the fluid in your drains. Your caregivers may remove your drain. Your nasogastric tube may be taken out once you have passed gas or had a bowel movement (BM).

  • 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.

  • Medicines:

    • 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.

    • Motility medicine: This medicine is given to help your stomach muscles move food and liquids out of your stomach faster. This medicine also may help you digest food better.

    • 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.

    • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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