The human urinary system normally has two kidneys, two ureters, one bladder and one urethra. The kidneys are bean shaped organs that filter your blood and remove water and waste through the urine. Connected to each kidney are narrow tubes called ureters. Ureters carry urine to the bladder. The bladder is the storage area for the urine until you are ready to urinate. The urine leaves the bladder through a narrow tube called the urethra. The female urethra passes through the vagina. The male urethra passes through the prostate gland and penis.
What happens to your urinary system when you have a Radical Cystectomy with an Orthotopic Neobladder?
A cystectomy is an operation to remove the bladder. In men, the bladder, prostate, seminal vesicles and lymph nodes are removed. In women, the bladder, urethra, part of the vagina and lymph nodes are removed. In addition, the uterus, fallopian tubes and ovaries may be removed.
After the bladder has been surgically removed, your doctor will create a new urinary resorvoir in place of the old bladder. Orthotopic means “in the same place”. Neobladder means “new bladder”. Your doctor will make a new bladder in the same place from a piece of the small intestine called an ileum. Once the piece is removed from your small intestine, it is reconnected.
The piece of the intestine that is removed to make the bladder is sewn together to form a pouch. The bottom portion of the pouch is connected to the urethra. This new pathway is made to act like your normal urinary system. Temporary tubes are used to drain your newly created bladder to help the healing process. They are ureteral stents, a suprapubic catheter and a urethral catheter. These drains will be described in more detail.
Since the neobladder has been created out of a piece of bowel, it will produce mucus. Mucus is a thick substance made by the lining of your intestine. This mucus can clog the tubes and build up on the lining of the neobladder, so you will learn to irrigate your catheter.
Your nurse will teach you how to irrigate your catheter. This will begin during your hospital stay and continue after discharge through your follow-up appointment. The catheter needs to be irrigated every six hours. Your doctor will tell you when you may stop.
The”new bladder” made out of small intestine may not work as well as a normal bladder, and may leak urine. This can happen especially at night. If the catheter does not drain well on its own, your doctor may have you use a catheter for a longer period of time. Your doctor will be following you closely to see how your new bladder is working and to answer any of your questions.
What Should You Do Before Surgery?
To be safe, talk with your doctor, surgeon and nurse about all herbals and remedies you use. Tell them how often and how much you take when you have your exam before surgery.
Studies are being done to learn more about how herbs and other remedies affect bleeding and anesthesia. Much is not known. Some herbs may change or lengthen the effects of medicines used with anesthesia. Others may affect bleeding or clotting. Some can change blood pressure or interact with medicines used during surgery. In some cases the effects may be slight but still important for the anesthesiologist and doctor to know about.
In many cases it is best to stop taking herbal remedies at least 2 to 3 weeks before surgery. Anesthesiologists here at OSUMC support this advice. The anesthesiologist is the doctor who balances the medicines that keep you safely in a very deep sleep for surgery. If it happens that you do not have enough time to stop taking herbs or remedies in advance of your surgery, bring them with you to show the doctor. Bring the products in their original bottle or container. This way the anesthesiologist can read what they contain and see how much you take.
Talking openly with the doctor about all herbal remedies and health practices before you have surgery is very important. This helps keep you safe.
Bladder Cancer Advocacy Network
American Bladder Cancer Society
Bladder Cancer WebCafe
National Comprehensive Cancer Center Network
Arthur G James Cancer Hospital and Richard J Solove Research Institute
www.cancer.osu.edu (The James)
American Cancer Society (ACS)
United Ostomy Associations of America Inc (UOAA)
The Phoenix Magazine