Information about Cystectomy For women

Contents

This sheet contains the following information about the cystectomy operation:

  • What is a cystectomy?
  • What exactly is done at the operation?
  • How will I pass urine after the operation?
  • How else will my body be affected?
  • Admission to hospital for your operation
  • Preparation for home
  • Getting back to normal
  • Follow up after a cystectomy
  • Useful addresses and telephone numbers

What is a cystectomy?

Cystectomy is the medical term for removal of the bladder. Cystectomy is sometimes referred to as a radical cystectomy, anterior pelvic clearance or a cystourethrectomy.


What exactly is done at the operation?

There are some variations in what has to be removed during a cystectomy operation. In women, the bladder, urethra (water pipe), uterus (womb) and front wall of the vagina are removed. In women who have gone through the menopause the ovaries are also removed. Internal lymph glands that lie within the pelvis are usually removed at the time of operation. It is important that your surgeon discusses the exact nature of the operation with you and that you feel that you understand what is going to happen during the operation before it is carried out.

How will I pass urine after the operation?

During the operation the surgeon carries out a procedure called a ‘urinary diversion’. The tubes that connect the kidneys to the bladder (the ureters) are disconnected from the bladder. The ureters are then joined to one end of a segment of bowel that is isolated from the rest of the intestine. This is then brought to the skin surface, usually on the right hand side of the abdomen. The end of the bowel that opens on to the abdomen is known as a stoma or a urostomy. Your urine then empties through this stoma into a small bag.

For some patients, a new bladder (neo bladder) can be formed from the bowel. If this is possible for you, the surgeon will discuss this with you.

How else will my body be affected?

Having a cystectomy involves surgery to the bowel as well as the bladder. A small portion of the bowel is used to make the urostomy, so the bowel that is left for digestion and absorption is shorter. This means that for some people their motions become looser after this type of surgery. Also the vagina is narrower, and although intercourse may be uncomfortable at first in the long term it is usually possible to resume a normal sexual relationship.

There are obviously major changes for you that happen after a cystectomy and it is important that you should be able to return to as active a lifestyle as possible after this operation. This depends on how you feel mentally as well as physically. There are people for you to talk to at the hospital and there is a network of patients who have had this type of surgery done who are willing to answer questions that you might have. Ask your doctor or nurse for more details.

What happens before the operation?

You will be requested to attend the pre-admission clinic before your admission date to have blood tests and examinations performed to ensure you are fit for the operation.

Admission to hospital for your operation

You will be admitted to ward 14 at the Bradford Royal Infirmary two days before your operation. This will be for a stay of around 7 - 10 days. You will meet the nursing and medical staff who will be looking after you. The nursing staff will give you some medicine that causes diarrhoea; this clears the bowel in preparation for your surgery. During this time you will be asked not to eat anything. We will encourage you to maintain a high fluid intake and some patients may require an I.V. drip on the night before the operation. A few hours before the operation we will ask you not to have anything more to drink until after the operation.

You will be seen by the stoma care nurse. She will prepare you for life with your stoma and teach you how to manage it after the operation. She will visit you and put a mark on your abdomen where your urostomy will be sited. It is important to do this with you whilst you are awake to ensure that it goes in the most suitable place. This will be away from any skin creases when you sit up, away from any previous operation scars and somewhere that you can see easily. She will also introduce you to the equipment that you will need so that you will be familiar with it after the operation. The stoma nurses will be able to provide you with a wealth of information, and will keep close contact with you after surgery and when you go home.

You will be seen by the Surgeon who will explain the operation to you again and ask if you have any further questions before asking you to sign the ‘consent form’ for surgery. If you are unsure about any aspect of the operation, please ask for more details from the medical or nursing staff.

We will be able to tell you the approximate time of your operation.

Day of operation

You will be seen by an anaesthetist who will discuss the type of anaesthetic you will be given. They will be interested in chest troubles, dental treatment and any previous anaesthetics you have had. The anaesthetist will discuss with you the different types of pain relief and discuss with you methods of controlling pain after the operation. The two most popular methods are a continuous slow infusion by which pain killers and local anaesthetic are given directly into the spinal nerve system. This involves inserting a very fine plastic tube into your back. This is called an ‘epidural’. The alternative is a special pump that delivers pain-killing medication into the blood stream when you press a button; this is known as ‘Patient Controlled Analgesia (PCA).

There is a risk that blood clots may form in the veins of the calf during surgery (known as "deep vein thrombosis") this may lead to a swollen, tender calf. Although this is easily treated, it can lead to further problems if the clots break away and float up into the lungs (Pulmonary Embolus). To help prevent this problem you will be given special ‘anti-embolic’ stockings to wear prior to surgery. You should keep these on during your stay on the ward. Your doctor will also prescribe daily injections during your hospital stay to thin the blood slightly and reduce the risk of clots forming.

You will be able drink until around 4 hours before surgery. This will let your stomach empty to prevent vomiting during operation. The nurses will advise you of the time to stop drinking. You will be asked to wear a cotton gown and remove all jewellery and may be given a sedative about one hour before the operation. This is to help relax you. You will be taken to theatre on a trolley accompanied by a nurse from the ward. Once in theatre your details will be checked again before your anaesthetic begins.

After your operation

Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed. After you come out of theatre, staff will transfer you to the recovery area in theatre for an hour or so until you are ready to return to the ward. Occasionally patients are moved to the High Dependency Unit overnight, so they can be observed more closely.

A team of anaesthetists and specialist nurses will see you to ensure that the pain is controlled with the epidural or PCA. This team will visit you daily in the first few days after your operation. After about two days the need for these types of pain killers is greatly reduced, and you will be able to have the systems removed. The ward staff will then give you pain killing tablets or injections instead. Please tell the staff looking after you if you are still in pain or discomfort.

You will have a drip running into a vein in your arm to give you fluids until you are able to drink normally (often about 3 to 4 days after the operation). When you are able to drink you will then be allowed to start to eat again (about 4 to 6 days after surgery). These times are only an ‘average’, as of course each person responds slightly differently.

As well as a dressing over your wound on your abdomen you will have a stoma bag, collecting urine from the new urostomy. You will notice thin tubes coming out of the urostomy. These are called stents. They will be removed around 7 days after your operation. There will be a gauze pack in the vagina which will be removed the following day. You will have a small plastic drain tube from your abdomen that will stay in place for about 3-5 days. You will also have staples in the skin wound; these will remain until the wound is healed. The staples are usually removed before you go home but sometimes this may be done by your district nurse.

The recovery period

The nursing staff will help you get out of bed on the first day after your operation and help you to start walking soon after this. Usually, people are up and about independently about 3 to 4 days after surgery. The stoma nurse will visit you regularly and teach you how to look after your stoma.

Preparation for home

When you are eating and drinking and the various drain tubes have been removed you will, by then, be taking part in caring for your urostomy. We will arrange a date for your discharge home when both you and the stoma nurse feel that you are able to look after the urostomy yourself. The stoma nurse will ensure that you have everything that you need for your urostomy when you get home, and will explain how to obtain further supplies. She will also arrange an appointment to see you again. The ward nurses will arrange for a district nurse to visit you at home whilst you are recovering. We will send a letter for your GP and you should have a week’s supply of any medication that you have been prescribed. An outpatient’s appointment will normally be made for you 6 weeks after your discharge home.

Getting back to normal

Recovery time after abdominal surgery varies but generally you should feel improvements from between 6-12 weeks. During the first 4 weeks you should not attempt to drive a car. During this time you should not attempt to lift or move heavy objects, start digging the garden or do housework. Getting back to work will depend on the type of job you do. Please ask your surgeon or specialist nurse if you are unsure. You should ask the ward sister for a ‘sick note’ before you go home.

Follow up after a Cystectomy

Follow up after a Cystectomy

We will see you six weeks after surgery in the out patient clinic. In the future you will be asked to come to this hospital for tests on your kidneys and urinary system. This may involve blood tests and special X-rays.

A final word

Please do not hesitate to contact us with any questions or concerns that you may have about your condition. We are here to help you.

Any questions?
If you have any questions please contact
Useful addresses and telephone numbers:
Website www.urol.co.uk Email rp@urol.co.uk

Uro-oncology nurse specialists
BRI Yorkshire Clinic
Mr David Tyson 01274 382079 Mrs Lyn Taylor 01274 550600
Miss Zoe Scaife

Ward 14 Ward 1
Bradford Royal Infirmary Yorkshire Clinic
Tel (01274) 364383 Tel (01274) 560311

Secretary to Mr R. Puri
Bradford Royal Infirmary Yorkshire Clinic
Duckworth Lane Bradford Road
Bradford BD9 6RJ Bingley BD16 1TW
Tel (01274) 382655 Tel (01274) 564521
If you have any further questions jot them down here:

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