Presentation on theme: "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."— Presentation transcript:
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 type Grade Stage
Stage Tumor invasion Nodes Metastasis This is the TNM system
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.
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 Diversion Higher 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
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%