Radical removal of the bladder and formation of a bladder substitute with bowel (female)

What is this?

This involves removal of the bladder, pelvic lymph nodes and, usually, remaining female organs (i.e. Ovaries, uterus and a portion of vagina) with formation of a bladder substitute using a segment of bowel

What alternatives are there?

Instillation treatment into the bladder, radiotherapy treatment to the bladder, removal of the bladder without construction of a bladder substitute (i.e. construction of a stoma), systemic chemotherapy (into the bloodstream) may be used but is not suitable for everyone

What to expect before procedure

Before the operation, you will have been counselled about the bladder substitute and what to expect. If you wish, you will be given the opportunity to meet someone who has previously had this procedure. You will come into hospital 1 day before the surgery. Sometimes you will be given laxatives so that your bowel can be prepared. Your stay will last approximately 18 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 who will mark a stoma site on your abdomen. 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 which improves or minimises post-operative pain. In the operation, the bladder and its lymph nodes will be removed. The ureters (the tubes which drain urine from the kidneys to the bladder) are then sewn to an separated piece of small bowel which is fashioned into a bladder substitute and joined to the water pipe (urethra). Alternatively, a catheterisable pouch (or reservoir) may be constructed. As part of the operation, it is usual to remove the uterus (womb), both ovaries and the upper part of the vagina. Most of the vagina is left in place and, for women who wish to be sexually active, this should be possible. The precise details of this aspect of your operation can be discussed in detail If you wish.

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 is possible. You will usually have a catheter in the urethra and a second catheter passing through the abdominal wall to the bladder; these catheters are normally removed after 2 weeks. Small tube drains will pass from the kidneys through the bladder substitute to a bag on the abdominal wall; these drains collect urine until they are removed after 7 days. An additional drain is usually placed in the abdomen itself and is removed after 4-5 days.. 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 18 days..

Potential side effects