Radical removal of the bladder and fashioning of an ileal conduit (male)

What is this?

This involves removal of the entire bladder, the prostate, the seminal vesicles (sperm sacs) and pelvic lymph nodes with permanent diversion of urine to the abdominal skin using a separated piece of bowel as a stoma

What alternatives are there?

Instillation treatment into the bladder, radiation treatment to bladder, formation of a new bladder or a continent pouch, systemic chemotherapy (given into the bloodstream)

What to expect before procedure

You will come into hospital 1 day pre-operatively. Your stay will last approximately 14 days. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and the Urology Nurse Practitioner. From the day before your operation you will have only fluids by mouth; you should take nothing by mouth for the 6 hours before surgery. You will also be given an enema to ensure that you pass a bowel motion on the morning of surgery. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

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. In the operation, the bladder, the prostate, the seminal vesicles (sperm sacs) and, If necessary, the urethra (water pipe) are removed. Almost invariably, the nerves which control erections are damaged as they run very close to the prostate; sometimes it is possible to preserve these nerves and this will be discussed with you beforehand. The ureters (the tubes which drain urine from the kidneys to the bladder) are then sewn to separated piece 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 separated, are then joined together again. You will be seen by a Urology Nurse Practitioner before your operation to mark the site where your stoma will be positioned and to try the various drainage bags available. If you wish, you will be given the opportunity to meet someone who has previously had this procedure.

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; visiting times in these areas are flexible and will depend on when you return from the operating theatre. 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 injections and 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 3-6 months, and possibly longer, for you to recover fully from this surgery. The average hospital stay is 14 days.

Potential side effects