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

What is this?

This involves removal of the entire bladder, prostate and pelvic lymph nodes with formation of a bladder substitute using a segment of bowel

What alternatives are there?

Instillation treatment into the bladder, radiation treatment to bladder, systemic chemotherapy (into the bloodstream), removal of the bladder with construction of a stoma

What to expect before procedure

You will come into hospital 1 day before 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. 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 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, the prostate and the seminal vesicles (sperm sacs) are removed along with the lymph nodes which drain the bladder. 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, the bowel may be fashioned into a catheterisable pouch (or reservoir).

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 2 months, and possibly longer, for you to recover fully from this surgery. The average hospital stay is 18 days.

Potential side effects