Urostomy Why? Patricia Anderson BSN RN CWOCN The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570 new cases of bladder cancer About 15,210 deaths from bladder cancer More common among men than women. More common among whites than blacks. Man having this cancer during his lifetime is about 1 in 26. For women, it is about 1 in 90. Risk Factor Cigarette smoking Exposure to aniline dye Schistosomiasis Chronic irritation of the bladder Patients treated with pelvic radiation Patients taking phenacetin Categorization of Cancers Histologic Grade Stage type Histologic types Transitional cell carcinoma: 95% Adenocarcinoma Squamous cell carcinoma Stage Tumor invasion Nodes Metastasis This is the TNM system Tumor Stage T 0 T carcinoma in situ T1 Superficial T2 Invasion T3 muscle Invasion through muscle into the fat surrounding the bladder and lymph nodes. T4 disease Superficial disease Borderline into the Superficial bladder cancers Treated topically with chemotherapy instillation Monitoring Only for recurrence 10 to 15% of superficial cancers develop into aggressive cancer Radical Cystectomy and Urinary Diversion Higher grade tumor Larger tumor Multiple tumors Carcinoma bladder in situ in multiple sites in the Preoperative Preparation Educational visit with WOC nurse Stoma marking Discuss outcomes, including sexuality changes Preoperative bowel preparation Patient will see their primary care physician for surgical clearance Types of Cystectomies Partial cystectomy: removes part of the bladder where tumor located. Simple cystectomy: removal of the bladder. Radical cystectomy: removal of the bladder, pelvic lymph nodes, urethra Men: prostate, the seminal vesicles, and part of the vas deferens. Women: the cervix, the uterus, the ovaries, the fallopian tubes, and part or all of the vagina. Radical Cystectomy and Creation of Ileal Conduit Involves Removal Lymph of the bladder nodes in the pelvis are included in this removal Conduit made from small bowel Ileal Conduit Mesentary stays connected Urethral stent Urostomy with stents Early Postoperative Complication Bleeding Wound infection Pelvic abscess Bowel obstruction Prolonged ileus Urine leak Ureteral obstruction Postoperative Care Hospital stay generally 5 to 7 days Mainly to return to normal bowel function and normal ambulation Generally have nasogastric tube for 2 to 3 days Urethral stents will be removed 5 to 14 days post op Continue pouching and stoma education Postoperative complications Stomal complications - stenosis, bowel necrosis, parastomal hernia, prolapse, retraction Complications related to ureterointestinal anastomoses - leakage, stricture, pyelonephritis 80% of patients will have asymptomatic bacteriuria Metabolic complications can occur Mortality post radical cystectomy Reported to be 1 to 3% References http://www.wisegeek.org/what-is-aniline-dye.htm http://medicaldictionary.thefreedictionary.com/phenacetin http://www.webmd.com/cancer/bladdercancer/cystectomy-for-bladder-cancer https://www.google.com/search?q=ileal+conduit&hl=e n&qscrl=1&rlz=1T4ADFA_enUS490US491&tbm=isc h&tbo=u&source=univ&sa=X&ei=M5cNU_SColwell, Goldberg, Carmel: Fecal and Urinary Diversions: Management Principles, Mosby 2009, pages 184 to 203.