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 smokingExposure to aniline dyeSchistosomiasis Chronic irritation of the bladder Patients treated with pelvic radiationPatients taking phenacetin

Categorization of Cancers

Histologic type

Grade

Stage

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

T2 T3 T4

Superficial disease Superficial disease Borderline

Invasion into the muscle

Invasion through muscle into the fat surrounding the bladder and lymph nodes.

Superficial bladder cancers

Treated topically with chemotherapy instillation

Monitoring for recurrence

Only 10 to 15% of superficial cancers develop into aggressive cancer

Radical Cystectomy and Urinary DiversionHigher grade tumor

Larger tumor

Multiple tumors

Carcinoma in situ in multiple sites in the bladder

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 of the bladder

Lymph 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://

medical-dictionary.thefreedictionary.com/phenacetin

http://www.webmd.com/cancer/bladder-cancer/cystectomy-for-bladder-cancer

https://www.google.com/search?q=ileal+conduit&hl=en&qscrl=1&rlz=1T4ADFA_enUS490US491&tbm=isch&tbo=u&source=univ&sa=X&ei=M5cNU_S-

Colwell, Goldberg, Carmel: Fecal and Urinary Diversions: Management Principles, Mosby 2009, pages 184 to 203.