Radical Removal of the Bladder and Fashioning of an Ileal Conduit

Female

The Procedure

This operation involves removal of the bladder, pelvic lymph nodes & remaining female organs (ovaries, uterus and a portion of the vagina) with permanent diversion of urine to the abdominal skin using an isolated loop of bowel as a stoma.

A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic to minimise post-operative pain.

Radical Removal of the Bladder and Fashioning of an Ileal Conduit Female

During the operation, the bladder and the urethra (water pipe) are removed. The ureters (the tubes which drain urine from the kidneys to the bladder) are then sewn to an isolated segment of small bowel which is positioned on the surface of the abdomen as an opening called a urostomy. The ends of the small bowel, from which the conduit is isolated, are then joined together again.

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As part of the operation, it is usual to remove the uterus (womb), both ovaries and the upper part of the vagina. Most of the vagina is left in place but it may be shorter in length due to the surgery. For women who wish to be sexually active, this may still be possible. The precise details of this aspect of your operation can be discussed in detail if you wish.

After the Procedure

After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward. You will have a drip in your arm and a further drip into a vein in your neck.

You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible.

You will usually have two tube drains in your abdomen and two fine tubes which go into the kidneys via the stoma to help with healing. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in

your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in

a chair for a short time soon after your operation. It will, however, take at least 2 months, and possibly longer, for you to recover fully from this surgery.

The average hospital stay is 14 days.

Side Effects

Most procedures have a potential for side-effects and these are outlined below.

Common (greater than 1 in 10)

Temporary insertion of a stomach tube through the nose, a drain and ureteric stents.
Discomfort or difficulty with sexual intercourse due to narrowing or
shortening of vagina.
In the event of removal of the ovaries, menopause may occur.

Occasional (between 1 in 10 & 1 in 50)

Infection in the abdominal cavity or in the wound.
Blood loss requiring repeat surgery.
Hernia of the incision requiring further treatment.
Decrease in kidney function with time.
The cancer may not be cured by the operation (this will be discussed with you before the operation).
Scarring, narrowing or hernia formation around the stomal opening requiring revision.

Rare (less than 1 in 50)

Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death).
Diarrhoea/vitamin deficiency due to shortened bowel requiring treatment.
Bowel and urine leakage from the anastomosis requiring re-operation.
Scarring of the bowel or ureters requiring further surgery.
Intra-operative rectal injury requiring colostomy.

Going Home

You will find that your energy levels are low when you get home and you will require assistance with many of the daily activities you normally take for granted. The wound clips will be removed in hospital or by the Community Nurse. You may experience problems with the stoma appliance in the early days, especially with leakage at night. As you become more familiar with your stoma and its fittings, this aspect will become less of a problem.

The time taken to return to normal activity is between 3 and 6 months.

There are a number of complications which may make you feel unwell and may require consultation with your GP or with Dr Rasiah.

If you experience fever or vomiting, especially if associated with unexpected pain in the abdomen, you should contact your doctor immediately for advice.

If you have any problems relating to the stoma or its attachments, you should contact the Community Nurse or Dr Rasiah’s rooms.