The intervention proposed to you is intendedto remove your cancerous bladder.
Urine secreted by the kidneys is drained by theureters to the bladder. The bladder is the reservoirin which urine is stored before beingevacuated during urination. This urination allowsthe evacuation of urine through the urethra.In women, this canal is short (around 4 cm) and it is surrounded by sphincters which ensure thecontinence.
The samples taken from yourbladder revealed a tumor.
The characteristics of this tumor justifyremoval of the bladder.
There are other support options thatare discussed by your urologist and/or by themultidisciplinary cancer committee: Treatments associated with surgery. Aintravenous chemotherapy can beproposed
The intervention proposed to you is intendedto remove your cancerous bladder.
Any surgical intervention requirespreparation which can be variable depending on eachindividual. It is essential that you follow therecommendations that will be given to you byyour urologist and your anesthesiologist.
In the event of non-compliance with these recommendations,the intervention could be postponed.Before each surgical procedure, apre-operative anesthesia consultation isnecessary. Report to your urologist andthe anesthetist your medical history,surgical and ongoing treatments,particularly anticoagulants (aspirin, clopidogrel,anti-vitamin K) whose use increases therisk of bleeding during the procedure butthe cessation of which exposes you to the risk of thrombosis(coagulation) of the vessels. The treatmentanticoagulant is suitable and possiblymodified before the intervention. Also indicate anyallergy.
The urine must be sterile for the operation:a urine analysis is therefore carried outbeforehand to check its sterility ortreat a possible infection, which couldlead to postponing the date of your operation.
A digestive preparation is offered incertain cases.In the case of external urine diversion, thechoice of stoma implantation sitethe abdomen is essential for the comfort of lifeulterior. You are educated in the practice oflocal care by a specialist nurse(stomotherapist).
The procedure takes place under anesthesiageneral. An antibiotic may be givenbefore the intervention.The first approach is:
– The replacement bladder: evacuationurine is done through the urethra by interposingan intestinal reservoir between the ureters andthe urethra.
– Direct connection of the ureters to the skin(cutaneous ureterostomy), which requires theinstallation of a drainage probe ineach ureter.
– The diversion of the ureters into the colon withelimination of urine through the anus.
– Continent diversion of urine to the skinby creating an intestinal reservoir, whichrequires regular intermittent catheterizationnight and day.
The choice between these different techniques dependsyour state of health and the type of tumor. Heis the subject of a pre-operative discussion withyour urologist and possibly withthe stoma therapist nurse.
Sometimes the choice must be changed duringthe intervention according to intraoperative findings.At the end of the intervention, depending on the diversionurine carried out, one or two bags are placedin place. In the case of a replacement ofbladder, catheters in the ureters and a catheterin the new bladder are positioned,even if one or more drains are placed at thelevel of the operating area; they allowmonitor flows from the siteoperatory.
In general, intestinal transit stopstemporarily reflexively in thefollowing this intervention and you will beallowed to feed you gradually fromthe resumption of it. During this period, youare nourished and hydrated intravenously.A tube exiting through one nostril (nasogastric tube)can be implemented in order torest your stomach.
Pain related to the procedure ispainkillers that are available to youadministered regularly.The time of removal of the drain(s) as wellthat urinary catheters is defined by yoursurgeon.If using an internal tank,Regular tank washings can berequired.
During your hospitalization, measures ofprevention of venous thrombosis (phlebitis)are put in place, which may call upon aearly mobilization, restraint oflower limbs (varicose stockings) and aanticoagulant treatment. These treatmentscan be continued after yourhospitalization and require checksregular biological tests by your attending physician.Advice and care regardingfunctioning of your bladder reservoir orthe fitting of your stoma is for youexplained during your stay.The duration of your hospitalization varies,decided by your surgeon based on thefollowing the operation, your general condition. mostoften it is 15 days.The result of the analysis of your samplebladder is not known until several days laterthe operation. It defines the extension of yourillness and/or the completeness or incompleteness ofsurgical excision. It conditions the choicepossible additional treatments(chemotherapy, radiotherapy). This result issent to your treating doctor and discussedduring the post-operative visit with yoururologist.
After a total cystectomy, you are a carriera urinary diversion which can be external(Bricker) or a neobladder (bladderbuilt in intestine). This information sheettherefore complete the one on the derivation which gave youbeen made and which we recommend that you read.After a cystectomy, you are also advisedto avoid effort and travelimportant in the first month followingthe intervention.Prescriptions given to youinclude care of the scar(s)skin as well as the daily injection of aanticoagulant. Maintaining treatmentanticoagulant is needed after yourhospitalization to prevent the risk ofphlebitis. Wearing compression stockings can bedesirable at least 10 days after yourintervention.
A letter has been sent to your doctortreating to keep them informed of your conditionhealth. The duration of convalescence and the date ofreturn to work or physical activitynormal depends on your physical condition. YOUdiscuss with your surgeon the date ofresumption of your activities and follow-up afterthe operation.A post-operative consultation isscheduled with your urologist in order toinform of the result of the microscopic examinationof your bladder and the managementlater. A follow-up is planned to controlthe absence of recurrence of the cancer, monitor therenal function, assess urinary functions andsexual and take care of possible effectsunwanted.
In the majority of cases, the intervention which youis proposed takes place without complications.However, any surgical procedure involves aa number of risks and complicationsdescribed below.Some complications are linked to your conditiongeneral.Any surgical intervention requiresanesthesia, whether loco-regional orgeneral, which carries risks. Theywill be explained during the preoperative consultationwith the anesthesiologist.Other directly related complicationswith intervention are rare, but possible.COMPLICATIONS COMMON TO ALLSURGERY ARE:
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