What is cystectomy with ileal conduit?

A cystectomy is surgery to remove the bladder. Sometimes other organs are also removed.

After your bladder is removed, the doctor makes a new way for you to pass urine. A common way is called an ileal conduit (say "ILL-ee-ul KON-doo-ut"). It's made from a piece of your intestine. One end connects to your ureters. These are the tubes that carry urine from the kidneys to the bladder. The other end connects to an opening the doctor makes in the skin of your belly. This is called a urostomy, or a stoma.

After the surgery, urine will pass out of your body through the stoma and into a plastic bag. A nurse with special training will teach you how to care for your stoma.

Most people go home within several days to 1 week after the surgery. To fully recover, you will probably need 6 to 8 weeks.

Depending on the reason for your surgery, removing your bladder may affect your sexual or reproductive life. If you have any concerns, talk to your doctor before your surgery.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Avoid lifting more than 5 pounds for about 4 weeks or until your doctor says it is okay. This may include a child, grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Ask your doctor when you can drive again.
• You will probably be able to go back to work or your normal routine in 4 to 6 weeks. This depends on the type of work you do and if you have any further treatment.
• You may take a bath or shower as usual. You can bathe with the pouch on or off. Gently pat the skin around your stoma dry after bathing.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids to avoid becoming dehydrated.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Other instructions

• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
• Follow your doctor's or WOCN's instructions for caring for your stoma.
• To control pain when you cough or sneeze, hold a pillow over your incision.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

A cystectomy is surgery to remove part or all of the bladder. The surgery is mainly used to treat bladder cancer.

After surgery, your belly will be sore. You will probably need pain medicine for 1 to 2 weeks. You can expect your urostomy (stoma) to be swollen and tender at first. This usually improves after 2 to 3 weeks. You may notice some blood in your urine or that your urine is light pink for the first 3 weeks after surgery. This is normal.

While you are recovering from surgery, you will also be learning to care for your stoma. You may find it helpful to meet several times with a wound ostomy continence nurse (WOCN). This nurse can teach you how to care for your stoma and use a urostomy pouch.

Many people can return to work or their usual activities 4 to 6 weeks after surgery. But you will probably need 6 to 8 weeks to fully recover from the surgery.

Bladder cancer surgery may affect sexual function. If a woman's uterus and ovaries are removed during the surgery, she will not be able to get pregnant, and menopause may start. She may have hot flashes and other symptoms of menopause. And if a man's prostate gland and seminal vesicles are removed, he may have problems getting an erection and will not be able to make a woman pregnant.

You may feel sad or depressed, or you may worry about how your body will look after surgery. You may worry about whether the surgery will affect your ability to have sex. These concerns are common. Ask your doctor about support groups or other resources that can help you with this. Call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org for more information.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 3 to 5 hours.
• You will have a plastic collection bag around your stoma to collect urine. You will also have small tubes called stents from your kidneys to the bag. The stents allow the connection between the ureter and your intestine to heal. They are usually removed in 2 to 4 weeks.