Download Cystectomy (Female) - East Cheshire NHS Trust

Cystectomy
(Female)
Information for patients
Urology Nurse Specialists Stockport 0161 4195695
Urology Nurse Specialists Tameside 0161 3316715
Urology Nurse Specialists Macclesfied 01625 661517
Ward C6 Stockport 0161 419-958
www.eastcheshire.nhs.uk
@eastcheshirenhs
Ref: 11507
Cystectomy (female) Ref: 11507
Review: 01/2016
Review: 01/2016
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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 women the urethra is in front of the vagina (birth canal).
The Urinary Bladder has 3 Functions.
It receives and stores urine that is made by the kidneys
It sense 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
women, this involves removing the uterus, ovaries and a cuff of the
vagina. In younger women, the ovaries can be left behind. Once
the bladder is removed, we need to consider how the urine will
drain from the kidneys.
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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 neobladder will connect to the
urethra (water-pipe) 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.
How will this affect me?
A cystectomy will make permanent changes to your body. Those
changes will affect urinary, sexual and reproductive function.
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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 and Reproductive Function
In women the uterus is removed although the ovaries can be
preserved in pre-menopausal women. The cervix and the top of
the vagina are removed, although this usually makes little
difference to intercourse. In more advanced tumours, a strip of
vagina may need to be removed which will affect the size of the
vagina. This can be improved after the operation with dilators if
required.
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 ‘Iooser' 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,
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
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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 be in hospital?
You will normally be in hospital for 10-14 days. But this may differ.
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
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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.
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.
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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.
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
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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.
• 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
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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.
Laparascopic 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.
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
Cystectomy (female) Ref: 11507
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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
Comments, compliments or complaints
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Cystectomy (female) Ref: 11507
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Review: 01/2016
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