BLADDER (URINARY) REMOVAL

General Information

DEFINITION--Removal of the urinary bladder and adjacent tissues and organs, and diversion of the urinary stream. This may involve an artificial opening, which is called an "ostomy" or "stoma."

BODY PARTS INVOLVED

• Males: Bladder; prostate; urethra; seminal vesicles; small intestine.
• Females: Urinary bladder; urethra; ureters; cervix; vagina; small intestine.

REASONS FOR SURGERY--Cancer of the bladder.

SURGICAL RISK INCREASES WITH

• Poor nutrition.
• Repeated surgeries on the bladder.

What To Expect

WHO OPERATES--Urologist.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of kidneys and chest.
• During surgery: Cystoscopy (See Glossary).

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the abdomen. The muscles are separated and the abdominal cavity is entered.
• The blood supply and the ureters are cut and tied.
• The bladder and adjacent tissues and organs are cut free and removed.
• The ureters are diverted through an intestinal pouch to an opening made in the skin (the stoma).
• The muscles are replaced and sewn together with sutures. The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Incisional hernia or infection.
• Impotence in males.
• Recurring urinary tract infections.
• Obstruction of the ureter.

AVERAGE HOSPITAL STAY--10 to 14 days.

PROBABLE OUTCOME--Expect complete healing of surgical wounds. You will need to wear an external pouch to collect urine. The stoma will heal and shrink to its permanent size in 2 to 4 months after surgery. Allow about 6 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--

vein blood clots.

• An enterostomy specialist (See Glossary) will help you and your family learn to cope with new urination habits. > Dry the area around the stoma by patting, not rubbing. Apply gauze soaked with 1 part vinegar to 3 parts water over the stoma to keep it clean.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as possible.

• Avoid vigorous exercise for 6 weeks after surgery. Avoid heavy lifting indefinitely. > Resume driving 3 weeks after returning home.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting, constipation or abdominal swelling.
• You have pain or difficulty with urination.
• You wish to consider penile implant surgery (if impotent).
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.