Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

Department of Urology

Search

Search

HOME

ABOUT US

PATIENT CARE
Patient Profiles
New Patient Packets
Patient Education
Office Procedures-What to
Expect
Female Urology - Pelvic
Medicine and
Reconstruction

PATIENT CARE

RESEARCH

EDUCATION

DIRECTORY

HOW TO GIVE

Home > Patient Care > Urologic Surgeries > Radical Cystectomy with Ileal Conduit Urinary Diversion

Radical Cystectomy with Ileal Conduit Urinary

Diversion
What does my urinary system look like?
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.

OSU Comprehensive Kidney

Stone Program
Urologic Robotic Surgery
Cancer
Minimally Invasive Surgery
Male Sexual and
Reproductive Medicine
Urologic Surgeries
HoLEP - Holmium Laser
Enucleation of the Prostate
Radical Cystectomy with a
Continent Catheterizable Urinary
Diversion
Radical Cystectomy with Ileal
Conduit Urinary Diversion
Radical Cystectomy with an
Orthotopic Neobladder

Radical Cystectomy with Ileal Conduit Urinary Diversion

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. An ileal conduit,
also called a urostomy, redirects the urine so it drains into a bag located on the abdomen. This type
of diversion will be created by removing a short segment of the small intestine (ileum) to be used as
a conduit for urine to flow out of the body. The ureters will be surgically sewn to the wall of the
conduit. The surgeon will close one end of the segment and then bring the open end through the
abdominal wall creating a stoma.

Vasectomy

Diseases and disorders

Community Outreach

Make An Appointment
Urology Video Library

The stoma is composed of mucus membrane of the intestine (inner lining) used to create the conduit.
After surgery, it will probably be swollen and may take several months for it to shrink to its

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Go

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

permanent size. The stoma should always be moist and red. Since the stoma does not contain any
nerve endings, it is not painful.

If it is rubbed or hit, the stoma may bleed easily. This minor, temporary bleeding is normal. After
surgery, a small plastic pouch will be attached to your abdomen surrrounding the stoma. There will
be two small stents sticking out from the stoma that will drain urine from your ureters into the pouch.
The pouch will have a spout at the bottom to drain the urine. The ET nurse will meet with you and
show you how to care for your ostomy.

In summary, the kidneys produce urine, which then travels through the ureters into the newly created
ileal conduit out through the stoma into a pouch to the abdomen.
Before Surgery
You will be told what time to arrive at the hospital.

You will be given a prescription for a bowel cleaner called GoLytely.

You will be given a bowel preparation guide. Follow the instructions on that guide.

You will be given prescriptions for two antibiotics called Neomycin and Erythromycin.

An electrocardiogram (EKG), chest x-ray, blood work and other tests may need to be done
prior to surgery. Your doctor and nurse will give you this information.
GoLytely Bowel Prep for Abdominal Surgery
A "bowel prep" is done to prepare the bowel for surgery or a procedure. Its purpose is to clear out the
bowel of all solid matter. Begin the bowel prep one day before your scheduled surgery.
You will need these items from a pharmacy:
Prescriptions for two antibiotics

Prescription for GoLytely

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

On the Day Before Your Surgery

1. Begin drinking only clear liquids 36 hours before surgery. You should not have any solid food
or milk products.

2. Drink plenty of clear liquids during the day to prevent dehydration. These clear liquids are
allowed:

Water

Ice

Clearbroth or bouillon

Coffee or tea (no milk or cream)

Kool-aid

Soft drinks

Jell-O (no red or purple)

Strained fruit juices (nopulp)

Popsicles

Gatorade

3. You should alsobegin the bowel clean outwith the GoLytely and antibiotics. Plan ahead so
you will have a bathroom nearby.You may need to get to the toilet right away. You will have
several bowel movements during the day. They will become very watery. The bowels are
"clear" or clean when there is only pale yellow fluid without flecks of stool.

4. Follow thisschedule for the bowel prep:

8:00am

Start drinking the GoLytely. Follow directions for mixing. Drink 1 glass every 15 minutes.
Finish drinking the gallon as soon as possible (may take a few hours).

1:00pm

Take the first dose of antibiotics (Neomycin and Erythromycin). Follow the dose
instructions on the prescription package or bottle.

2:00pm

Take the second dose of antibiotics (Neomycin and Erythromycin). Follow the dose
instructions on the prescription package or bottle.

11:00pm

Take thelast dose of antibiotics (Neomycin and Erythromycin). Follow the dose
instructions on the prescription package or bottle.

Midnight

Do not eat or drink anything after 12 midnight. You may gargle but do not swallow any
liquid. Do not smoke after 12 midnight.

Day of Surgery
Take medicines the day of surgery, as prescribed by your doctor, with small sips of water.
Bring all your medicines with you (in the original containers) when you come to the hospital.
When you arrive for your surgery, you and your family should report to the:

Hospital Admissions Office

Room 105, Rhodes Hall

450 W 10th Avenue, Columbus, OH 43210

Medicines You Must Stop Taking Before Surgery
These medicines must be stopped 7-10 days before surgery. Check with your surgeon:
Aggrenox

Plavix

Coumadin

Vitamin E
These medicinies must be stopped 5-14 days before surgery. Check with your surgeon:

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

Aspirin

Ibuprofen (Advil and Motrin)

Naproxen (Aleve)
After Surgery
Once your surgery is finished, you will be moved to the Post Anesthesia Care Unit (PACU) for 1 to 2
hours. Your doctor will decide if you need to transfer to the Surgical Intensive Care Unit (SICU) or a
hospital room. You will be connected to monitors, drains and tubes. The following is a list of what to
expect after surgery.
Oxygen (O2): You may remain on this for 1 to 2 days depending on your levels. Your nurse
will check your O2 levels with your vital signs every 4 hours.

Nasogastric Tube (NG): This tube is placed during surgery through your nose ending in your
stomach. It helps drain your stomach contents, which helps let the bowel heal. This tube will
be in for 5 to 7 days. You may have a sore throat and dry mouth. Mouth swabs can be used to
help with the discomfort. While this tube is in place, you will not have anything to eat or drink.
Your doctors will decide when the tube can be removed, usually when your bowels regain
function.

Central Venous Catheter (CVC): Since you will not be eating, you will have intravenous (IV)
fluids. These fluids will enter into a large vein in your body, often in the neck/chest through a
CVC. It is a thin, soft, plastic tube that is inserted during surgery and will be used for IV fluids,
medicines, blood transfusions and withdrawing blood samples.

Patient Controlled Analgesia (PCA): A small pump with a supply of pain medicine ordered by
your doctor will be attached to your IV line. The pump is set so that you can push the button
when you have pain. This will give a small amount of the pain medicine into your blood stream
for quick relief. You are the only person allowed to push the button. Your nurse will give
you further instructions about this pump.

Sequential Compression Devices (SCDs): A sleeve is placed around each leg. This sleeve is
connected to a pump. This pump forces air into different parts of the sleeve in sequence,
creating pressure around the calves. This pressure pushes the blood through the vessels in
your legs to prevent blood clots. You will wear these during the night while resting, and
throughout the day, except when you are out of bed and/or walking.

Incentive Spirometer: This is a device that will help keep your lungs healthy after surgery.
Your nurse and respiratory therapist will teach you how to use your spirometer. By using the
Incentive Spirometer, you will help reduce your risk of lung infection and/or breathing
difficulties.

Incision:Your surgeon will makean incision on your abdomen from above the bellybutton to
the pubic bone.Staples will be used to close the wound. A dressingwill be placed over the
incision for a few days. Your surgeon will remove thedressing and the incisionwill remain
open to air while it is healing.

Ileal Conduit (Urostomy):Your urostomy stoma most often will be locatedin the right lower
portion of your abdomen.A small, clear pouch will be attached around the stoma to collect
urine. There will be two thin tubes calledureteric stents that willbe seen through the stoma.
They help with the flow of urine while the surrounding tissue heals. The stents will be removed
before you go home.

Hemovacs: Hemovacs are a type of drainage collection device that help promote healing by
draining fluid from the wound. The drainage tube is placed during your operation, through the
skin into the wound near the surgical incision. It is held in place by stitches. Usually, you will

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

have two drains (one on each side of the abdomen) that will remain in place until you are
discharged.
Enterostomal Therapy (ET)Nurse
This is a nurse who specializes in the care of patients with urinary diversions. The ET nurse will teach
you and your family about the care and management of your urostomy before you leave the hospital.
You will meet with the ET nurse on the day of surgery and they will mark your abdomen for stoma
placement. The ET nurse will visit you during your hospital stay and use hands-on teaching and
videos to help you learn how to care for your new urostomy
Patient Care Resource Manager
Before you go home from the hospital you will meet with a Patient Care Resource Manager (PCRM).
This member of your health care team will work with you and your family to assist with any needs
you may have when you are discharged. Once you are home, you or your family should contact the
PCRM if you have any additional needs or questions regarding your care.

You may need a home health nurse, medical equipment or moved to a Skilled Nursing Facility (SNF)
when you are discharged. If this is the case, your PCRM will work with your doctor and other
members of the team to arrange what you need.
Discharge
Your nurse will give you the following information when you are discharged from the hospital.
An appointment to see your doctor

Important phone numbers

Home health care agency information

Signs/symptoms of infection

Instructions on wound and drain care

A list of current medicines and prescriptions

Activities you can or cannot do while healing from surgery

Herbal Use Before Surgery
It has been shown that taking some herbal remedies may cause complications for people having
surgery. Use of a small amount of herbs to season food is not a problem. The American Society of
Anesthesiologists lists the use of herbs and remedies that could cause problems. Some of these
herbs are known by other names. Read the package labels carefully. Here is the list:
Echinacea

Ephedra

Feverfew

Garlic

GBL, BD and GHB (abbreviations used for remedies taken for body building, weight loss aid
and sleep)

Ginger (high doses)

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

Ginkgo biloba

Ginseng

Goldenseal

Kava-kava

Licorice

Saw Palmetto

St John's Wort

Valerian

Vitamin E
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 Websites

Cancer-Related Resources
Bladder Cancer Advocacy Network
www.bcan.org 888-901-BCAN
The Bladder Cancer Advocacy Nerwork (BCAN) is a nonprofit organization dedicated to
advancing research, providing information and support to the bladder cancer community, and
raising awareness of bladder cancer across the country.
American Bladder Cancer Society
www.bladdercancersupport.org
This website offers information, resources and support for people with bladder cancer.
Bladder Cancer WebCafe
www.blcwebcafe.org
The WebCafe presents information on current treatment options for bladder cancer in an
unbiased way. This website also helps users find more resources available on the internet.

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

National Comprehensive Cancer Center Network

www.nccn.org 888-909-NCCN(6226)
NCCN is an organization of cancer centers, including The James. The site has treatment
guidelines, links to treatment centers and more.
Arthur G James Cancer Hospital and Richard J Solove Research Institute
http://cancer.osu.edu/ (The James) 800-293-5066
This site has information and links about cancer, about The James, cancer prevention,
detection, treatment, support programs, clinical trials and survivor news. You can link to
patient education materials or be referred to a doctor. Note, this is our site, so we are biased.
American Cancer Society (ACS)
www.cancer.org Ohio: 888-ACS-OHIO
ACS gives information about cancer, treatment, caregiving, and skills to survive. It is easy to
use and has good links to local offices and more. Also has information about anemias.

Ostomy Resources
United Ostomy Associations of America Inc (UOAA)
www.uoaa.org 800-826-0826
The UOAA is a national organization that provides support and information to people with an
ostomy and their caregivers.
The Phoenix Magazine
http://www.phoenixuoaa.org/ 949-600-7296
This is the official publication of the UOAA. It's the leading source for ostomy product
information, personal stories and practical management tips.

Medical Identification Bracelet

It is important for you to purchase a medical identification bracelet. In an emergency, this bracelet will
let doctors and nurses know that your bladder has been surgically removed and a new one made. It
should be worn at all times. The bracelet shoud have the following words printed on it.
"I have a urostomy pouch worn on my abdomen."
You can purchase a bracelet at any of the following locations:
American Medical ID

949 Wakefield, Suite 100

Houton, TX 77018

1-800-363-5985

Website: www.americanmedical-id.com
MedicAlert Foundation

2323 Colorado Ave

Turlock, CA 95382

1-888-633-4298

Website: www.medicalert.org
Medic IDInternational

POBox 571687

Tarzana, CA 95382

1-800-926-3342

Website: www.medicid.com

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Radical Cystectomy with Ileal Conduit Urinary Diversion :: Department of Urology

Department of Urology

915 Olentangy River Road, Suite 2000

Columbus, OH 43212

Phone: 614-293-8155

Copyright The Ohio State's Wexner Medical Center

http://urology.osu.edu/20970.cfm[9/28/2016 07:02:22]

Contact Us

Site Map

Privacy Policy

Terms of Use

OneSource

OSUCCC - James

College of Medicine

Wexner Medical Center

Ohio State