1. Urostomy Why? Patricia Anderson BSN RN CWOCN

2. 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

3. 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.

4. Risk Factor  Cigarette smoking  Exposure to aniline dye  Schistosomiasis  Chronic irritation of the bladder  Patients treated with pelvic radiation  Patients taking phenacetin

5. Categorization of Cancers  Histologic type  Grade  Stage

6. Histologic types  Transitional cell carcinoma: 95%  Adenocarcinoma  Squamous cell carcinoma

7. Stage  Tumor invasion  Nodes  Metastasis  This is the TNM system

8. Tumor Stage  T 0  T carcinoma in situ  T1  T2  T3  T4  Superficial disease  Borderline  Invasion into the muscle  Invasion through muscle into the fat surrounding the bladder and lymph nodes.

9. Superficial bladder cancers  Treated topically with chemotherapy instillation  Monitoring for recurrence  Only 10 to 15% of superficial cancers develop into aggressive cancer

10. Radical Cystectomy and Urinary Diversion  Higher grade tumor  Larger tumor  Multiple tumors  Carcinoma in situ in multiple sites in the bladder

11. 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

12. 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.

13. 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

14. Ileal Conduit

15. Mesentary stays connected

16. Urethral stent

17. Urostomy with stents

18. Early Postoperative Complication  Bleeding  Wound infection  Pelvic abscess  Bowel obstruction  Prolonged ileus  Urine leak  Ureteral obstruction

19. 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

20. 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

21. Mortality post radical cystectomy  Reported to be 1 to 3%

22. References  http://www.wisegeek.org/what-is-aniline-dye.htm http://www.wisegeek.org/what-is-aniline-dye.htm  http://medical- dictionary.thefreedictionary.com/phenacetin http://medical- dictionary.thefreedictionary.com/phenacetin  http://www.webmd.com/cancer/bladder- cancer/cystectomy-for-bladder-cancer http://www.webmd.com/cancer/bladder- cancer/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_S- 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_S-  Colwell, Goldberg, Carmel: Fecal and Urinary Diversions: Management Principles, Mosby 2009, pages 184 to 203.