Radical Cystectomy

What is a Radical Cystectomy?

Removal of the bladder, the pelvic lymph nodes and some surrounding tissue . In men, the prostate gland and seminal vesicles are also removed. In women, the uterus, ovaries and top of the vaginal wall may be removed, depending on where the cancer is.

What is an Ileal Conduit?

A means of draining urine out of the body when the bladder has been removed - see diagram above and What does the operation involved.

What is the benefit of this operation?

The aim is to cure bladder cancer.

What are the risks?

  • Common Infection due to insertion of temporary drains, stents following surgery
  • Bleeding requiring the need for blood transfusion
  • (Women) Pain or difficulty with sexual intercourse due to narrowing or shortening of vagina.
  • Menopause may occur if ovaries removed
  • (Men) High risk of impotence (inability to have erections) , Dry orgasm, Retrograde ejaculation: no semen is produced causing infertility
  • Occasional Blood loss requiring further surgery
  • Rare Infection or hernia of incision requiring further treatment
  • Anaesthetic or heart problems possibly requiring admission to intensive care (including chest infection, clot in the lung or leg, stroke, heart attack and death)
  • Decrease in kidney function over time
  • Very rare Diarrhoea due to shortened bowel/vitamin deficiency requiring treatment
  • Bowel and urine leakage from anastamosis (join) requiring further surgery
  • Scarring to the bowel or ureters requiring further surgery in the future
  • Scarring, narrowing or hernia formation around the stoma opening requiring further surgery
  • Damage to the bowel during surgery resulting in the need for a colostomy

Are there any alternatives?

Radiation treatment to the bladder, continent urinary diversion. If these options are suitable for you, your doctor will have discussed

What happens before the operation?

Before your operation you will be asked to attend the Pre-Anaesthetic Clinic. This is to check that you are fit for your operation. You will be asked questions about your general health and will have some or all of the following tests: blood and urine tests, chest x-ray and ECG (heart tracing). These are routine tests before an operation. You will also have the opportunity to ask any questions.

You will be referred to the Stoma Nurse or ur doctor will discuss the operation with you, answer any questions you may have and decide where your stoma should be placed . A mark will be made on your abdomen (tummy) after you have discussed this. The stoma will be on the right side of your abdomen, just below the waist.

Additional Treatment

After your operation you will be started on daily subcutaneous injections of Fragmin (Daletparin), this also helps reduce your risk of blood clots.

Your operation

You will be admitted onto the ward the day before your operation, you will be informed of this at pre-anaesthetic clinic.

An anaesthetist will see you at this time to discuss your anaesthetic and pain control. A doctor will again discuss the operation and possible complications, answer any questions you may have and ask you to sign your consent form again.

You will be asked not to eat or drink any non clear fluids, such as soup, milk etc, for 6 hours before your operation.

After this you will be asked not to drink anything further.

You will be given bowel cleanser solution to clear your bowel before your surgery. Before going to theatre you will be asked to have a shower and put on a hospital gown and special stockings. These stockings help reduce your risk of getting clots in your legs. If you are feeling anxious and it is appropriate, you may have been prescribed some relaxing medication (pre-med), this will be given to you on the ward before you go to theatre. A nurse will accompany you to theatre where you will be taken to the anaesthetic room where you will have your anaesthetic.

What does the operation involve?

A cut will be made on your abdomen (tummy) from just above your navel to the top of the pubic bone to enable the doctor to get to the bladder. Once the bladder is removed your doctor needs to create another way for your urine to drain from the body; this is done by forming a stoma. Other names you may hear stomas being called are ileal conduit.

To form an ileal conduit/stoma, a small piece of your bowel (intestine) is normally used. The doctor will cut out a small piece of your bowel (removing this should not affect how your bowel works). The ureters (tubes which drain urine from the kidneys) are then stitched into one end of the small piece of bowel which was removed, urine can then drain into it. The other end comes out through a small opening on your abdomen to make the stoma. Urine can then drain from the ureters, through the piece of bowel and out through the stoma into a special bag fitted around your stoma. The bag is held in position by a sticky patch attached to the bag.

The operation will take about 4 hours. After the operation, you will be taken to the recovery room and will stay there for an hour or more before going back to your ward. This allows you to recover from the anaesthetic. You will be drowsy when you return to the ward and may want to arrange that only a close relative visit on the first day, so that you can have some quiet time to recover.

What will happen after the operation?

The nurses will make regular checks of your blood pressure, pulse, breathing, wound, pain and urine output. As you get better, these checks will be done less often.

The tubes and drains you may have are listed below. Do not worry about them, they are there to give you fluids or to drain fluids away. They will gradually be removed, as you get better.

  • Oxygen You may be given oxygen for a short time after your operation until you are more alert and awake.
  • Intravenous infusion (IVI or drip) A cannula (thin plastic tube) will be put into a vein in your arm and/or your neck and fluid will be given through this to make sure you do not get dehydrated. It can also be used to give you intravenous antibiotics, blood etc. When you are drinking and do not feel sick the IVI will be removed.
  • Drains - You will have 1 drain (tube) coming out of your lower abdomen. This drains away blood or fluid, which can collect after your prostate is taken out. It is normally removed after 1-2 days. If it is still draining large amounts, it will be left in a little longer.
  • Catheter A thin tube which is passed into the bladder through the urethra (water pipe) to drain the blood or urine. Will be removed in few days time, depending on how is it draining per day.
  • Wound - you will have a dressing over the wound for a few days after the operation. Clips will have been used to keep the two edges of the skin together, these look just like staples and are normally removed 10-12 days after the operation. The wound will heal and over time the scar will fade.
  • An Epidural catheter will be inserted on your back by the anesthetist in operating room to control your pain. The anaesthetist will have discussed these with you before
    the operation. When you are eating and drinking and can take painkillers by mouth, the Epidural can be removed. It is important your pain is controlled, if not, let your nurse know.
  • You will be encouraged to get up and about as soon as possible. This is to help reduce complications such as chest infections, pressure sores or a clot in the leg (Deep Vein Thrombosis - DVT).
  • Drains - You will have 1 or 2 drains (tubes) coming out of your lower abdomen (stomach). They drain away blood or fluid, which can collect after your bladder is taken out. They will normally be removed after 2-3 days. If they are still draining large amounts, they will be left in a little longer.
  • Stoma - You will have 2 small tubes (stents) coming out of your stoma. They come down the ureters (tubes from the kidney) and out through the stoma. They allow the joins where the ureters are stitched into the stoma to heal. They will get expelled on its own.
  • Wound - you will have a dressing over the wound for a few days after the operation. Where your doctor made the cut, clips will have been used to keep the two edges of the skin together. These look just like staples, they are removed 10-12 days after the operation. The wound will heal and over time the scar will fade. You should be ready to go home after 10 days. Before you leave you will be shown how to manage your catheter and catheter bags at home. You will be given contact numbers in case you have any problems.

Will I have any follow up?

An outpatient appointment will be made for you to come back to clinic 10 -12 days after your operation for clips removal and to review the Histopathology report.

Discharge Information

Care of your wound

Your clips are removed after 10-12 days after surgery.

Your wound should have healed well on the outside by this time and a dressing is usually not needed. If your wound becomes red, tender/hot to touch or is discharging fluid/pus you should inform your doctor, you may have developed a wound infection.

Care of your stoma

Make sure you have enough stoma bags and supplies before you go home and have the stoma nurse's telephone number in case you need to contact him/her.

Medicines to take home

You may be given painkillers to take home, use them as you need to but no more than the recommended dose. Your nurse will discuss this with you before you go home. You should continue to take your normal medicines unless advised otherwise.

Bowels

Constipation can be a problem after your operation you may need a laxative until things return to normal. Ask your nurse or doctor for advice if this is a problem.

Washing

You can have a bath or shower once you are home, gently pat dry around your wound rather than rubbing dry.

Driving

You should wait at least 4-6 weeks and avoid long journeys during this time. You can then drive when you feel comfortable to carry out an emergency stop.

Sex

You will be able to resume sexual activity when you feel comfortable to do so but you may wish to wait 6-8 weeks before sexual intercourse to allow healing. Women may experience pain or difficulty with sexual intercourse due to the narrowing or shortening of the vagina after surgery. You may need to try different ways and positions in order to find what is easier for you.

Many men are unable to achieve an erection after surgery due to nerves necessary for erections being damaged or cut. Treatments are available to help overcome this. If you are having problems you can discuss them with your doctor .

Work

You can normally return to work after about 6-8 weeks, this does depend on what you do. Manual workers, or work which involves heavy lifting, may require 8-12 weeks off work. You should discuss this with your doctor before you leave hospital. If you need a sick certificate you should ask the ward nurses for this.

General advice

You will be able to eat and drink normally. Take it easy for about 4-6 weeks but take gentle exercise like walking, gradually increasing what you do, as you feel able. Avoid strenuous exercise for 6-8 weeks.

Avoid lifting heavy objects for 6-8 weeks.

If you live alone or are elderly you may want a friend or relative to stay for the first few days.

If you will need help at home after you are discharged, you should discuss this at your pre-admission visit.

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