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Cystectomy

Cystectomy

A cystectomy is an operation to remove the bladder. If an ileal conduit is being performed then this also involves removing the urethra.

A cystectomy is performed when the bladder is cancerous. Bladder cancer is the fourth most common cancer in males.

Before the operation

You will be admitted to hospital a day the morning of your operation for preparation for surgery.

The following will be done on admission:

  • Admitted to ward and seen and consented by consultant and anaesthetist.
  • With ileal conduit formation, the area around where the stoma is to be sited will need to be marked by the stoma CNS. The surgical incision site may need to be shaved.
  • A course of phosphate enema is administered per rectum to ensure that the bowel is completely empty before surgery. (however, this is not a standard protocol for all Urologists).
  • Once bowel preparation has been completed you should have nothing to eat, but can continue drinking clear fluids up until two hours before the operation.
  • Ensure IV access is in place to start rehydrating you before the operation.
  • Pre-operative blood specimen and urine culture should be sent for analysis as per local protocol, is not pre-assessed.
  • An ECG and a chest x-ray will be required if you are aged sixty and over, and with significant cardiac history.
  • If on anticoagulation therapy, this should be stopped 3-10 days before surgery, as per local protocol.

    What happens during the operation?

        • The surgeon marks a site over the site of the bladder where the bladder is removed.
        • Once the bladder is removed, a Robinson drain is inserted and left in place to drain off any bleeding from the operation site. The drain is removed when the drainage output is less than 50 mls in 24 hours.

    With Ileal Conduit Formation

    Currently, the most commonly used method of creating a new reservoir is by making an ileal conduit or urostomy, during the cystectomy operation.

        • A length of a small bowel is isolated with its blood supply. The remainder of the small bowel is reconnected by stitching both ends together. The ureters are attached to one end and the other brought out to the abdomen.
        • Once plumbed out to the outer skin, the stoma will be attached to secure its position.
        • Two stents, one in each ureter, will be placed and will remain for 1-2 weeks to ensure urine drains out while the stoma is initially inflamed and the joins are healing.

    With Neo Bladder Replacement

    It is sometimes possible to construct a new bladder. It is necessary to teach the patient do intermittent self-catheterisation (ISC). This is because the bowel produces mucus, which may cause blockage in the urethra. Regular bladder flushes are also required.

        • A 60 cm length of isolated bowel is formed into a new pouch to store urine and the ureters attached.
        • The urethra is then connected to the neo bladder.

    With Continent Urinary Diversion

    During the cystectomy operation, a longer segment of isolated bowel is formed into a pouch and the ureters attached. The pouch stores urine. A further piece of bowel is then tunnelled to the skin surface to form an opening (stoma).

    The stoma does not drain urine and requires the patient to pass a catheter through the stoma into the pouch to drain the stored urine.

        Normally, you will require to self- catheterise 4-5 times daily.

    After the operation, you will be transferred from the theatre suite to the recovery area, then to Intensive Care Unit (ICU) for immediate postoperative recovery period.

    In ICU, you are monitored closely in a specialist clinical environment for the first 24 to 48 hours.

    Once stable, you will be transferred to the main ward, and should start drinking in about 8 hours.

    The naso-gastric tube (NGT) is removed when you can start drinking orally.

    You can start eating when there is presence of bowel sounds and/or start passing wind, as this indicates that the bowel is working.

    Eating and drinking while the bowel is not working often causes vomiting as the products cannot be broken down and absorbed.

    The operation is likely to take about 4-6 hours, and hospital stay is 5 days, if there are no complications.

    It is advisable to have about 4-6 weeks off work, and you can resume to your daily exercises, such as walking after one week.