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CYSTECTOMY (MALE) An Information Leaflet Urology Nurse Specialists Stockport 0161-419-5695 Urology Nurse Specialists Tameside 0161=331-6715 Urology Nurse Specialists Macclesfied 01625-661517 Ward C6 Stockport 0161-419-5958 Macclesfield District General Hospital www.eastcheshire.nhs.uk @eastcheshirenhs Ref: 11506 Cystectomy (Male) Ref: 11506 Review: 01/2016 Review: 01/2016 Page 1 Introduction Your consultant has recommended that you have a cystectomy (removal of the bladder), as a treatment option for your bladder cancer. This booklet will discuss what a cystectomy involves, and help you become better informed about this operation and what it will mean for you. It will also help guide you in making the right choice of operation. It will cover the following: • Preparing for your operation • The operation • Your stay in hospital • Possible side effects • After care once you go home What is the Urinary Bladder? The bladder is a hollow, muscular balloon-like organ that collects and stores urine. It is found in the lower part of the abdomen. The kidneys produce the urine (which is made up of water and waste products), thin tubes then carry the urine to the bladder. The bladder stores urine until it is full, and empties through a tube called the urethra. In men, the prostate gland surrounds the lower part of the bladder. The Urinary Bladder has 3 Functions. • It receives and stores urine that is made by the kidneys. • It senses when you need to pass urine. • The muscle in the bladder wall contracts to empty the bladder. What is a cystectomy? A cystectomy involves the removal of the entire bladder. In men, this involves removing the prostate and possibly the urethra. This can to impotence (problems getting an erection). Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 2 Once the bladder is removed, we need to consider how the urine will drain from the kidneys. There are 2 options that your consultant may offer you. One is to bring the urine out via a small section of bowel. This is called an ileal conduit. An alternative method is to create a new bladder out of a larger section of bowel. The neo-bladder will connect to the urethra (waterpipe) allowing the chance of passing and storing urine in a much more normal way. Not all patients are suitable for this. What is an Ileal Loop Diversion? In this option the ureters are connected to a small piece of your bowel and this is brought out into the skin surface of your abdomen. The tubes that connect the kidneys to the bladder (ureters) are disconnected from the bladder. The ureters are then joined to one end of a segment of your bowel that is isolated from the rest of your bowel. This is then brought to the skin surface, usually on the right hand side of your abdomen. The end of the bowel that opens onto your abdomen is known as a stoma or urostomy. Your urine then empties through the stoma into a small external bag. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 3 How will this affect me? A cystectomy will make permanent changes to your body. Those changes will affect urinary and sexual function. Urinary Function An ileal conduit simply diverts the urine from the kidneys into a loop of bowel and into a bag on your side. You will have no sensation to need to pass urine again. It will now continually drain into the bag. Sexual Function. In men, the prostate (the gland that produces a fluid which forms part of the semen) and the seminal vesicles (where the semen is stored) are removed with the bladder. The nerves that supply erections run under this gland and although they can be preserved it is likely that spontaneous erections will be lost after surgery. There are medications and devices that can help with erections. Internal lymph nodes that lie within your pelvis are usually removed at the time of your operation. It is important that you discuss the exact nature of your operation with the surgeon, and feel that you understand what is going to happen during the operation, before you sign a consent form. Bowel Function Occasionally there may be a change in the frequency of your bowel motions. They may also be a little 'looser' than prior to the operation. This is because of the shortening of the bowel after removing a portion for the operation. Preparing for your operation Before any decision is made about surgery, your consultant will present your individual case to a multi-disciplinary team. It will then be discussed with you the best options of management in the clinic. You will also be allocated a specialist nurse if you don't already have one allocated to you. You will be sent an appointment to attend a pre-operative assessment clinic. Here you will have a number of investigations, Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 4 including blood tests and an ECG (heart tracing). You will be informed about any changes you will need to make to any of your current medications. If the anaesthetist needs to see you before your operation, an appointment will be made for this. Please inform your specialist nurse if you take Warfarin, aspirin, or any medication to thin your blood. You will have further opportunity to see and liaise with your specialist nurse prior to your operation. She will consent you for the operation and answer any questions, concerns you may have. Before your operation, you will be seen by a Stoma specialist nurse. They will discuss the position of your urostomy with you. She will visit you, or see you in the clinic and put a mark on your abdomen, where the urostomy will be sited. It is important that this happens whilst you are awake, to ensure that it is placed in the best position for you. This will mean it should be away from the skin creases when you sit up. It should be away from any previous operation scars, and somewhere that you can easily see it. You will be admitted the day before your operation. You will receive confirmation of this from your consultant's secretary through the post. Once in hospital you will be on restricted diet and fluids. You will also be given something to help clear the bowels ready for your operation. You will have nothing to eat or drink for 6 hours before your operation. You will be given injections to thin your blood prior to your operation, to prevent blood clots. These will continue after your operation as well. The anaesthetist will visit you and discuss your anaesthetic and postoperative pain relief. This is a good opportunity to ask any questions that you may have prior to your operation. Your operation will take about 5-6 hours. How long will I be in hospital? You will normally be in hospital for 10-14 days. But this may differ. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 5 After your Cystectomy. A bed will be booked for you in the High Dependency Unit (HDU) or Intensive Care Unit (ICU). Your condition can be monitored very closely. This is often necessary after major surgery, as you will have spent a long time under the anaesthetic. Once your consultant and anaesthetist are happy with your recovery, you will be sent back to the ward, to continue your recovery. You will be given regular painkillers, as discussed with you by the anaesthetist.This may be either: • A pain killer device that you control. This will release painkillers into your blood stream through a drip. This is called Patient Controlled Analgesia (PCA). • An epidural by which pain killers and local anaesthetic are given directly into the spinal nerve system. This involves inserting a very fine tube into your back at the time of your operation through which these drugs can be given. After a few days, the need for these drugs will slowly reduce, and when you are able to take pain killing tablets these will be given. Injections can also be given. It is important to tell staff if you are experiencing any pain that is not being controlled, as your recovery will be quicker if your pain is controlled. You will be given some oxygen through a mask. This will need to stay in place for about 2 or 3 days. You will have 2 drains around the wound area. These will be removed between days 4-6 after your operation. They are placed around the wound area to drain any blood or fluid remaining internally after the operation. These will be monitored, and fluid will be sent from the drain sites at regular intervals post operatively to check for infection and to look at the composition of the fluid. You will have a dressing over the wound on your abdomen. Your stitches/clips will be removed around 10 days after your operation. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 6 You will have stents in your stoma. These are left in place for 10 days. They drain the urine directly from the ureters through the loop of bowel. They are removed via the urostomy. Your blood pressure, pulse and temperature will be taken frequently to make sure that they are within normal limits. Bloods will be taken on a regular basis, to check your kidney function, blood count, and infection risk. Eating and Drinking You will not be able to eat or drink for a while after your operation, to allow your bowel time to heal. Gradually, you will be able to drink, and then eat, as your gut returns to normal activity. We ask you to chew chewing gum, to help restore your gut activity. You will be told when to use this after your operation. We do expect you to have some weight loss following surgery, and we will talk to you about have high calorie drinks and food to help you with your nutrition following surgery. Getting up and around The operation carries with it the risks that any major operation contains. These include: • Chest infection • Deep vein thrombosis (a blood clot forming in one of the veins in the leg) • Wound infection • Pressure sores The nurses and physiotherapists will work to prevent these from occurring. You will be encouraged to get up and about as soon as possible and you will be taught a range of leg and breathing exercises to perform, in order to prevent complications from occurring. You will be given a pair of tight white surgical stockings to wear to help the blood circulation in the legs. Injections to thin the blood slightly to prevent clots from forming will continue after your operation. For at least 10 days. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 7 Preparation for home following Surgery When you are eating and drinking and the various drain tubes have been removed, you will begin caring for your urostomy. Once you are confident in looking after this, we will plan for your discharge home. The stoma nurse will ensure that you have everything you need for your urostomy when you get home and explain how to get additional supplies. The ward nurses will arrange for the district nurse to visit you at home during your initial recovery period. A letter will be sent to your GP explaining what has happened during your stay in hospital and you will be given a supply of any new medication which may have been started whilst you were in hospital. You will also be given a copy of the GP letter. You will be sent an outpatient clinic appointment to discuss your histology once reviewed by your consultant. Long term, we will also want to regularly review you, over the next months and years. Your nurse specialist will also be available for you to contact at any time. Going Home Allow yourself plenty of rest. Gentle exercise may be taken after a few days but you will need to avoid heavy exercise for at least a month after you go home. Try to plan for going home before your admission to hospital. If you think that you will need help with things like shopping or cleaning when you get home, please tell the nursing staff or your nurse specialist so that help can be put in place for you. Getting back to normal Recovery time after abdominal surgery varies but generally you should feel improvements between 6-12 weeks. During the first 6 weeks after your operation you should bear the following in mind: • You should NOT drive a car. After 6 weeks, you can consider if you would feel comfortable to do an emergency stop without difficulty. You also need to contact your insurance company to check that you are covered to resume driving. Your GP can also sign you fit to drive. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 8 • You should NOT attempt to lift or move heavy objects or perform heavy household work. • You should ask your surgeon when you can return to work. This may vary depending on the type of job you do. You can obtain a sick note for the time you are expected to be off work before leaving the ward. Your GP will issue you with a fitness to return to work certificate when you are fit to return to work. • You can have a bath or a shower as soon as the drains and stents are removed. You should not use perfumed soaps or talcum powder until your wound is well healed. • You can resume sexual relations as soon as you feel comfortable, which may take several weeks. Most men are usually left impotent by this surgery so please speak to your consultant if you wish to be advised of methods to overcome this. Laparoscopic Surgery Keyhole surgery means using a laparoscope to do surgery. A laparoscope is a long tube with an eyepiece at one end and a camera at the other. This type of surgery can be used to remove the bladder (Iaparoscopic cystectomy) through several very small cuts in the tummy (abdomen). So you only have a few small wounds and can recover from your operation more quickly. You can talk to your surgeon about whether this type of surgery may be suitable in your case. It is not possible for some people because the surgeon may not be able to see the area of the bladder as clearly as with open surgery and there is a higher chance of bowel complications. Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 9 Useful Contacts Urology Nurse Specialists Stockport 0161-419-5695 Urology Nurse Specialists Tameside 0161=331-6715 Urology Nurse Specialists Macclesfied 01625-661517 Ward C6 Stockport 0161-419-5958 Macmillan Support http://www.macmillan.org.uk/ References Title: Types of surgery for invasive bladder cancer Author(s): Cancer Research UK Link: http://www.cancerresearchuk.org/cancer-help/type/bladdercancer/treatment/invasive/surgery/types-of-surgery-for-invasive-bladdercancer Title: Surgery for invasive and advanced bladder cancer Author(s): Macmillan cancer care Link: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Bladder/Advanc edbladder/Surgery.aspx Title: Your sex life and bladder cancer Author(s): Cancer Research UK Link: http://www.cancerresearchuk.org/cancer-help/type/bladdercancer/living/your-sex-life-and-bladder-cancer Cystectomy (Male) Ref: 11506 Review: 01/2016 Page 10 Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation contact Communications and Engagement on 0800 195 494. Admission information The trust accepts no responsibility for the loss of, or damage to, personal property of any kind, in whatever way the loss or damage may occur, unless deposited for safe custody. Please leave valuables at home. If you need to bring personal items that are expensive, for example micro hearing aids, please be aware that you do so at your own risk East Cheshire NHS Trust is committed to ensuring that patients and staff will always be treated with dignity and respect. There will be no age, disability, gender, race, sexual orientation or religious discrimination Cystectomy (Male) Ref: 11506 NHS Direct (part of NHS Choices) is a 24 hr phone advice service providing confidential health advice and information. Phone: 0845 4647 (Textphone 0845 606 46 47) www.nhs.uk Review: 01/2016 Page 11