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Cystectomy With Continent Cutaneous Urinary Diversion

WHAT YOU NEED TO KNOW:

Cystectomy with continent cutaneous urinary diversion is surgery to remove your bladder. Your surgeon will create a urostomy to help urine drain from your kidneys out of your body. He will make a new bladder from a piece of your intestine. The new bladder will be connected to an opening called a stoma on your abdomen.

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.
  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.
  • You may need to donate blood before your surgery. Your blood will be stored in case you need it during or after your surgery.
  • An enema may be given to help empty your bowel. An enema is liquid medicine put in your rectum.
  • Medicines may be given to prevent a bacterial infection or to prevent blood clots.
  • Anesthesia is medicine to make you comfortable during the surgery. Healthcare providers will work with you to decide which anesthesia is best for you.
    • 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.
    • Local anesthesia is a shot of medicine put into the skin of your abdomen. It is used to numb the area and dull the pain. You may still feel pressure or pushing during surgery.

During your surgery:

  • Your surgeon will make an incision in your abdomen near your umbilicus (belly button). He will remove your bladder and may remove nearby organs. In men, the organs include the prostate and seminal vesicles (glands near the prostate). In women, the organs include the uterus, cervix, ovaries, and fallopian tubes. Your surgeon may also remove part of the urethra and lymph nodes near your bladder.
  • Your surgeon will then remove part of your intestine. He will make a new bladder by connecting the section of intestine to your ureters. Two small stents (tubes) will be placed inside the ureters into the kidney to help urine drain while you heal. Your surgeon will connect part of the new bladder to an opening on your abdomen. He may also use part of your appendix. He will close your incision with stitches or staples.

After your surgery:

You will be taken to a room to rest until you are fully awake. Healthcare providers will monitor you closely for any problems. Do not get out of bed until your healthcare provider says it is okay. When your healthcare provider sees that you are okay, you will be able to go home or be taken to your hospital room.

  • You may need to walk around the same day of surgery , or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your healthcare provider says you can. Talk to healthcare providers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let healthcare providers know you need help.
  • Deep breathing and coughing will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out, and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath. Then let the air out and cough. Repeat these steps 10 times every hour.
  • You will be able to drink liquids and eat certain foods once your stomach function returns. 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 foods easily, you may slowly begin to eat solid foods.
  • Drains and tubes:
    • Drains are thin rubber tubes put under your skin to drain fluid from around your incision. The drains will be taken out when your surgery site stops draining blood or other fluid.
    • Catheters are used to drain urine and fluid from the new bladder. Do not pull on the tubes or let them kink. Keep the bag of urine below the catheters to prevent urine from flowing backward into your bladder. This could cause an infection.
    • A nasogastric (NG) tube may be put in your nose and down into your stomach. The tube is attached to suction that keeps your stomach empty. This tube may help get your bowels working. Sometimes food or medicine can be given through the NG tube.
  • Intake and output of liquids may be needed. Healthcare providers record the amount of liquid you are getting and how much you are urinating. Healthcare providers may need to strain your urine to check for stones. Do not flush your urine down the toilet unless healthcare providers say it is okay.
  • Bladder irrigation keeps your bladder clean and helps it heal. Healthcare providers will irrigate your bladder 2 to 3 times a day.
  • Medicines:
    • Antibiotics help treat or prevent an infection caused by bacteria.
    • Antinausea medicine calms your stomach and prevents vomiting.
    • Pain medicine may be given. Do not wait until the pain is severe before you ask for more medicine.
    • Bowel movement softeners are given to make it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

RISKS:

Surgery may increase your risk for bleeding or infection. Urine may leak where the ureters are connected to the section of intestine. Your ureters may also become blocked and not empty urine. You may get a blood clot in your leg or arm. Your symptoms may become worse if you do not have surgery. The above conditions may also become life-threatening.

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.

© 2016 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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