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Contents
This sheet
contains the following information about the cystectomy operation:
- What
is a cystectomy?
- What
exactly is done at the operation?
- How
will I pass urine after the operation?
- How
else will my body be affected?
- Admission
to hospital for your operation
- Preparation
for home
- Getting
back to normal
- Follow
up after a cystectomy
- Useful
addresses and telephone numbers
What
is a cystectomy?
Cystectomy
is the medical term for removal of the bladder. Cystectomy
is sometimes referred to as a radical cystectomy, anterior
pelvic clearance or a cystourethrectomy.
What
exactly is done at the operation?
There
are some variations in what has to be removed during a cystectomy
operation. In women, the bladder, urethra (water pipe), uterus
(womb) and front wall of the vagina are removed. In women
who have gone through the menopause the ovaries are also removed.
Internal lymph glands that lie within the pelvis are usually
removed at the time of operation. It is important that your
surgeon discusses the exact nature of the operation with you
and that you feel that you understand what is going to happen
during the operation before it is carried out.
How
will I pass urine after the operation?
During
the operation the surgeon carries out a procedure called a
‘urinary diversion’. The tubes that connect the kidneys to
the bladder (the ureters) are disconnected from the bladder.
The ureters are then joined to one end of a segment of bowel
that is isolated from the rest of the intestine. This is then
brought to the skin surface, usually on the right hand side
of the abdomen. The end of the bowel that opens on to the
abdomen is known as a stoma or a urostomy. Your urine then
empties through this stoma into a small bag.
For some
patients, a new bladder (neo bladder) can be formed from the
bowel. If this is possible for you, the surgeon will discuss
this with you.
How
else will my body be affected?
Having
a cystectomy involves surgery to the bowel as well as the
bladder. A small portion of the bowel is used to make the
urostomy, so the bowel that is left for digestion and absorption
is shorter. This means that for some people their motions
become looser after this type of surgery. Also the vagina
is narrower, and although intercourse may be uncomfortable
at first in the long term it is usually possible to resume
a normal sexual relationship.
There
are obviously major changes for you that happen after a cystectomy
and it is important that you should be able to return to as
active a lifestyle as possible after this operation. This
depends on how you feel mentally as well as physically. There
are people for you to talk to at the hospital and there is
a network of patients who have had this type of surgery done
who are willing to answer questions that you might have. Ask
your doctor or nurse for more details.
What
happens before the operation?
You
will be requested to attend the pre-admission clinic before
your admission date to have blood tests and examinations performed
to ensure you are fit for the operation.
Admission
to hospital for your operation
You
will be admitted to ward 14 at the Bradford Royal Infirmary
two days before your operation. This will be for a stay of
around 7 - 10 days. You will meet the nursing and medical
staff who will be looking after you. The nursing staff will
give you some medicine that causes diarrhoea; this clears
the bowel in preparation for your surgery. During this time
you will be asked not to eat anything. We will encourage you
to maintain a high fluid intake and some patients may require
an I.V. drip on the night before the operation. A few hours
before the operation we will ask you not to have anything
more to drink until after the operation.
You
will be seen by the stoma care nurse. She will prepare you
for life with your stoma and teach you how to manage it after
the operation. She will visit you and put a mark on your abdomen
where your urostomy will be sited. It is important to do this
with you whilst you are awake to ensure that it goes in the
most suitable place. This will be away from any skin creases
when you sit up, away from any previous operation scars and
somewhere that you can see easily. She will also introduce
you to the equipment that you will need so that you will be
familiar with it after the operation. The stoma nurses will
be able to provide you with a wealth of information, and will
keep close contact with you after surgery and when you go
home.
You
will be seen by the Surgeon who will explain the operation
to you again and ask if you have any further questions before
asking you to sign the ‘consent form’ for surgery. If you
are unsure about any aspect of the operation, please ask for
more details from the medical or nursing staff.
We
will be able to tell you the approximate time of your operation.
Day
of operation
You
will be seen by an anaesthetist who will discuss the type
of anaesthetic you will be given. They will be interested
in chest troubles, dental treatment and any previous anaesthetics
you have had. The anaesthetist will discuss with you the different
types of pain relief and discuss with you methods of controlling
pain after the operation. The two most popular methods are
a continuous slow infusion by which pain killers and local
anaesthetic are given directly into the spinal nerve system.
This involves inserting a very fine plastic tube into your
back. This is called an ‘epidural’. The alternative is a special
pump that delivers pain-killing medication into the blood
stream when you press a button; this is known as ‘Patient
Controlled Analgesia (PCA).
There
is a risk that blood clots may form in the veins of the calf
during surgery (known as "deep vein thrombosis")
this may lead to a swollen, tender calf. Although this is
easily treated, it can lead to further problems if the clots
break away and float up into the lungs (Pulmonary Embolus).
To help prevent this problem you will be given special ‘anti-embolic’
stockings to wear prior to surgery. You should keep these
on during your stay on the ward. Your doctor will also prescribe
daily injections during your hospital stay to thin the blood
slightly and reduce the risk of clots forming.
You
will be able drink until around 4 hours before surgery. This
will let your stomach empty to prevent vomiting during operation.
The nurses will advise you of the time to stop drinking. You
will be asked to wear a cotton gown and remove all jewellery
and may be given a sedative about one hour before the operation.
This is to help relax you. You will be taken to theatre on
a trolley accompanied by a nurse from the ward. Once in theatre
your details will be checked again before your anaesthetic
begins.
After
your operation
Although
you will be conscious a minute or two after the operation
ends, you are unlikely to remember anything until you are
back in your bed. After you come out of theatre, staff will
transfer you to the recovery area in theatre for an hour or
so until you are ready to return to the ward. Occasionally
patients are moved to the High Dependency Unit overnight,
so they can be observed more closely.
A
team of anaesthetists and specialist nurses will see you to
ensure that the pain is controlled with the epidural or PCA.
This team will visit you daily in the first few days after
your operation. After about two days the need for these types
of pain killers is greatly reduced, and you will be able to
have the systems removed. The ward staff will then give you
pain killing tablets or injections instead. Please tell the
staff looking after you if you are still in pain or discomfort.
You
will have a drip running into a vein in your arm to give you
fluids until you are able to drink normally (often about 3
to 4 days after the operation). When you are able to drink
you will then be allowed to start to eat again (about 4 to
6 days after surgery). These times are only an ‘average’,
as of course each person responds slightly differently.
As
well as a dressing over your wound on your abdomen you will
have a stoma bag, collecting urine from the new urostomy.
You will notice thin tubes coming out of the urostomy. These
are called stents. They will be removed around 7 days after
your operation. There will be a gauze pack in the vagina which
will be removed the following day. You will have a small plastic
drain tube from your abdomen that will stay in place for about
3-5 days. You will also have staples in the skin wound; these
will remain until the wound is healed. The staples are usually
removed before you go home but sometimes this may be done
by your district nurse.
The
recovery period
The
nursing staff will help you get out of bed on the first day
after your operation and help you to start walking soon after
this. Usually, people are up and about independently about
3 to 4 days after surgery. The stoma nurse will visit you
regularly and teach you how to look after your stoma.
Preparation
for home
When
you are eating and drinking and the various drain tubes have
been removed you will, by then, be taking part in caring for
your urostomy. We will arrange a date for your discharge home
when both you and the stoma nurse feel that you are able to
look after the urostomy yourself. The stoma nurse will ensure
that you have everything that you need for your urostomy when
you get home, and will explain how to obtain further supplies.
She will also arrange an appointment to see you again. The
ward nurses will arrange for a district nurse to visit you
at home whilst you are recovering. We will send a letter for
your GP and you should have a week’s supply of any medication
that you have been prescribed. An outpatient’s appointment
will normally be made for you 6 weeks after your discharge
home.
Getting
back to normal
Recovery
time after abdominal surgery varies but generally you should
feel improvements from between 6-12 weeks. During the first
4 weeks you should not attempt to drive a car. During this
time you should not attempt to lift or move heavy objects,
start digging the garden or do housework. Getting back to
work will depend on the type of job you do. Please ask your
surgeon or specialist nurse if you are unsure. You should
ask the ward sister for a ‘sick note’ before you go home.
Follow
up after a Cystectomy
Follow
up after a Cystectomy
We
will see you six weeks after surgery in the out patient clinic.
In the future you will be asked to come to this hospital for
tests on your kidneys and urinary system. This may involve
blood tests and special X-rays.
A final
word
Please
do not hesitate to contact us with any questions or concerns
that you may have about your condition. We are here to help
you.
Any
questions?
If
you have any questions please contact
Useful
addresses and telephone numbers:
Website www.urol.co.uk
Email rp@urol.co.uk
Uro-oncology
nurse specialists
BRI Yorkshire
Clinic
Mr
David Tyson 01274 382079 Mrs Lyn Taylor 01274 550600
Miss
Zoe Scaife
Ward
14 Ward 1
Bradford
Royal Infirmary Yorkshire Clinic
Tel
(01274) 364383 Tel (01274) 560311
Secretary
to Mr R. Puri
Bradford
Royal Infirmary Yorkshire Clinic
Duckworth
Lane Bradford Road
Bradford
BD9 6RJ Bingley BD16 1TW
Tel
(01274) 382655 Tel (01274) 564521
If
you have any further questions jot them down here:
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