Cystectomies,Bladder

Diversionsand
PostoperativeCare
RobinMorashRN,BNSc.,MHS
AdvancedPracticeNurse
Bladder Cancer Canada
November 18, 2013

Tonightsgoals

ReviewAPNroleinbladdercancer
Reviewthedifferenttypesofurinarydiversion
Describeprosandconsofurinarydiversions
Reviewwhattoexpectaftersurgery
Movingforwardwithabladderdiversion

APNRole

APNinBladderCancerCare
Historyofrole Why?
Complexpatients
Multipletransitions
Identifiedneeds

CancerAssessmentClinic
Educationandsupport
Classes
Ongoingsupportbefore/aftertreatment
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Educationandsupport

Decisionmaking
Preoperativeprep
Generalpostoperativecare
Recoveryaftersurgery
Careathome:ostomy,neobladder
Sexuality,erectilefunction
Whattoexpect:normalvs.abnormal
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PatientEducation

MaleUrinarySystem

FemaleUrinarySystem

RadicalCystectomy
Allofthebladderisremoved
Inmentheprostateandseminalvesiclesarealso
removed
Inwomentheuterus,ovaries,cervixandpartof
thevaginamayberemoved
Nearbylymphnodesarealsoremoved
Anewwayismadeforurinetobecollectedfrom
thekidneysandstored=UrinaryDiversion
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UrinaryDiversionOptions
Duringthecystectomysurgery,oncethebladderis
removed,theurologistwillcreateanewwayfor
urinetoleavethebody.
UrinaryDiversions:
1. IlealConduit(1950s)
2. Continentreservoirpouch(1980s)
3. Neobladder(1980s)

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1.IlealConduit
Ashortpieceofthesmall
intestineisremoved
andconnectedtothe
ureterscreatinga
passagewayknownasan
ilealconduit.
Urineflowsfromthe
kidneysthroughtheureters
intotheilealconduit.
Theconduitisconnectedto
theskinonthefrontofthe
abdomenbyanopening
calledastoma.
Incontinentdiversionto
skin
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Stoma

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IlealConduitUrostomyBag
Asmallbagisplaced
overthestomato
collecttheurine.
Theurinecomesout
continuouslyinsmall
amounts.
Thebagneedstobe
emptiedonceitisfull.

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ProsandConsofanIlealConduit
Pros
Simpletoperform
Leastpotentialforpost
treatment
complications
Noneedfor
catheterization
Lessabsorptionofurine
Formanypeople:
simpletocarefor
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Cons
Needtowearan
externalcollectionbag
Stomacomplications
(e.g.hernia)
Impairedbodyimage
Costofsupplies
Perceivedlimitsto
leisure/socialactivities
Forsomepeople:
awkwardtocarefor

2.Catheterizable ContinentPouch
Avalveiscreatedinapouch
madefromapieceofsmall
intestine.
Thevalveallowsurinetobe
storedinthepouch.
Itisemptiedseveraltimes
eachdaybyplacinga
drainagetube(catheter)into
thestomathroughthevalve.
Continentdiversiontoskin
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3.Neobladder
Aurinaryreservoir
(neobladder)ismadefroma
pieceofsmallintestine.
Theuretersareconnected
totheneobladder.
Theneobladderisalsosewn
totheurethraallowingyou
toeventuallyurinate
throughyoururethra.
Continentdiversionto
urethra
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Neobladder

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ProsandConsofaneobladder
Pros
Noexternalbagor
stomatomaintain
Urinatethrough
urethra
Maynotneed
catheterization
Bodyimage

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Cons
Incontinence(1030%)
Urineretention(520%)
Potentialcomplications
(e.g.infection)
Needforspecificexercise
andpelvicfloormuscle
strengthening
Needtotrain neobladder
Mayneedtolearnhowto
catheterize

SurgicalCare

WhattoExpectAfterSurgery

OvernightinRecoveryRoom(PACU)
710daysinhospital
Upwalking2nd day
Slowreturntonormaldiet
Paincontrol
CCAC Homecare

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AfterDischarge appointments
Returnappointmentwillbescheduledondischarge
Discussionofsurgeryandpathologyresults
Decisionregardingnextsteps&planofcare:
Thismayincludeapossiblereferraltoamedical&/or
radiationoncologistforchemotherapyorradiation
Futureplansforbloodworkand/orimaging

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AfterDischarge Care

Activity
Nutrition
Careofyourincision
Careofyoururinarydiversion
Ilealconduit ostomy,drainagebag
Neobladder temporarycatheter

Followupcarewithyoururologistmayvary
Followup q3monthsx1year
Followup q6monthsx3years
Thenannualvisits
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Ostomy/IlealConduitCare
EnterostomalTherapy(ET)Nursewillbeconsulted
beforesurgerytomarkthemostappropriatespoton
theabdomenforthestomaandbeavailableon
surgicalunitsaftersurgery
Youmustbeabletoempty,rinseandclosethe
pouchbeforegoinghome
Youwillbeprovidedwithsamplesofostomy
productsondischarge.
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InstructionsforNeobladder
Patients

Hydration Fluidintake
UrinaryCatheterCare(temporary)
Flushingyoururinarycatheter(irrigating)
Kegel(pelvicfloor)exercises
Newurinatingaction

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Pelvicfloormuscles

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GoingForward
Bekindtoyourself,bepatient!
Accepthelpfromothers
Keepasenseofhumour
Askquestionsifunsure
Itmaytake36monthstoreachyournew
normal urinarypattern
Supportgroups

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Whichisthebestoptionforyou?
Somepeoplewillnotbeabletohaveachoiceof
urinarydiversions.Thisisbasedonanumberof
factorsthatwillbediscussedbetweenyouand
yourUrologist
Forthosepeoplethatdohavetheopportunityto
choose,itisaveryindividualdecision.Youneed
toconsider:
Impactsonyourlifestyle
Personalpreferences
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Supports

Yourhealthcareteam
HospitalPsychosocialOncologyteam
Communityresources
CanadianCancerSociety
BladderCancerCanada
Website:www.bladdercancercanada.org
OttawaSupportGroup

JoinaWalk!!

Ottawa, September 2013

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