Mr. Kilian Walsh

Patient Information Leaftets

This information is provided by Urology West for patients who are undergoing treatment with Urology West and have been advised of specific conditions and treatments.

- Cystectomy

Definition
Cystectomy is a surgical procedure to remove the bladder.

Purpose
Cystectomy is performed to treat cancer of the bladder. Radiation and chemotherapy are also used to treat bladder cancer. Surgery is used to remove cancer when it is in the muscle of the bladder.

Precautions
Cystectomy is an aggressive treatment that may not be appropriate for patients with superficial tumors that respond to more conservative treatment.

Description
Cystectomy is a major surgical operation. The patient is placed under general anaesthesia. An incision is made across the lower abdomen. The ureters are located, tied and cut. The ureters connect the kidneys to the bladder. Cutting them frees the bladder for removal. The bladder and associated organs are removed. In men the prostate is removed with the bladder. In women, the uterus, fallopian tubes, ovaries, and part of the vagina are removed with the bladder. The bladder collects urine from the kidneys for excretion at a later time. Since the bladder is removed, a new method must be created to remove the urine. A small piece of the small intestine is removed, cleaned, and tied at one end to form a tube. The other end is used to form a stoma, an opening through the abdominal wall to the outside. The ureters are then connected to the tube. Urine produced by the kidneys now flows down the ureters, into the tube, and through the stoma. The patient wears a bag to collect the urine.

Preparation
The medical team will discuss the procedure and tell the patient where the stoma will appear and what it will look like. The patient receives instruction on caring for a stoma and bag. Counselling may be initiated. A period of fasting and an enema may be required.

Aftercare
After the operation, the patient is given fluid-based nutrition until the intestines being to function normally again. Antibiotics are given to prevent infection of the incision sites. The nature of the organs removed mean that there will be major lifestyle changes for the person undergoing the operation. Men will become impotent because nerves controlling penile erection are cut during removal of the bladder. In women, infertility is a consequence because the ovaries and uterus are removed. However, most women who undergo cystectomy are postmenopausal and past their childbearing years.
Both men and women are fitted with an external bag that connects to the stoma and collects the urine. The bag is generally worn around the waist under the clothing. It takes a period of adjustment to get used to wearing the bag. Because there is no bladder, urine is excreted as it is produced, essentially continuously. The stoma must be treated properly to ensure that it does not become infected or blocked. Patients must be trained to care for their stoma. Often there is a period of psychological adjustment to the major change in life style created by the stoma and bag. Patients should be prepared for this by discussion with their physician.

Risks
As with any major surgery, there is a risk of infection; in this case infection of the intestine is especially dangerous as it can lead to peritonitis (inflammation of the membrane lining the abdomen).

Normal results
The bladder is successfully removed and a stoma created. Intestinal function returns to normal and the patient learns proper care of the stoma and bag. He or she adjusts to lifestyle changes and returns to a normal routine of work and recreation, some sports excluded.

Abnormal results
The patient develops an infection at the incision site. The patient does not make a successful psychological adjustment to the long term consequences of impotence and urinary diversion. In some women, the vagina is constricted, which may require a secondary procedure.

Key Terms
Ureters: Tubes that connect the kidneys to the bladder. Urine produced by the kidneys passes through the ureters to the bladder.

You can download this information in PDF format here: Cystectomy.pdf

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