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Urostomy Why?. Patricia Anderson BSN RN CWOCN. The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are: About 72,570 new cases of bladder cancer About 15,210 deaths from bladder cancer. More common among men than women. - PowerPoint PPT Presentation
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Urostomy
Why?
Patricia Anderson BSN RN CWOCN
The American Cancer Society’s estimates for bladder cancer in the United States for 2013 are:
About 72,570 new cases of bladder cancer
About 15,210 deaths from bladder cancer
More common among men than women.
More common among whites than blacks.
Man having this cancer during his lifetime is about 1 in 26.For women, it is about 1 in 90.
Risk Factor
Cigarette smokingExposure to aniline dyeSchistosomiasis Chronic irritation of the bladder Patients treated with pelvic radiationPatients taking phenacetin
Categorization of Cancers
Histologic type
Grade
Stage
Histologic types
Transitional cell carcinoma: 95%
Adenocarcinoma
Squamous cell carcinoma
Stage Tumor invasion
Nodes
Metastasis
This is the TNM system
Tumor Stage
T 0 T carcinoma in situ T1
T2 T3 T4
Superficial disease Superficial disease Borderline
Invasion into the muscle Invasion through
muscle into the fat surrounding the bladder and lymph nodes.
Superficial bladder cancers
Treated topically with chemotherapy instillation
Monitoring for recurrence
Only 10 to 15% of superficial cancers develop into aggressive cancer
Radical Cystectomy and Urinary DiversionHigher grade tumor
Larger tumor
Multiple tumors
Carcinoma in situ in multiple sites in the bladder
Preoperative Preparation
Educational visit with WOC nurse
Stoma marking
Discuss outcomes, including sexuality changes
Preoperative bowel preparation
Patient will see their primary care physician for surgical clearance
Types of Cystectomies Partial cystectomy: removes part of the bladder
where tumor located. Simple cystectomy: removal of the bladder. Radical cystectomy: removal of the bladder, pelvic
lymph nodes, urethra Men: prostate, the seminal vesicles, and part of the
vas deferens. Women: the cervix, the uterus, the ovaries, the
fallopian tubes, and part or all of the vagina.
Radical Cystectomy and Creation of Ileal Conduit Involves
Removal of the bladder
Lymph nodes in the pelvis are included in this removal
Conduit made from small bowel
Ileal Conduit
Mesentary stays connected
Urethral stent
Urostomy with stents
Early Postoperative Complication
Bleeding Wound infection Pelvic abscess Bowel obstruction Prolonged ileus Urine leak Ureteral obstruction
Postoperative Care Hospital stay generally 5 to 7 days
Mainly to return to normal bowel function and normal ambulation
Generally have nasogastric tube for 2 to 3 days
Urethral stents will be removed 5 to 14 days post op
Continue pouching and stoma education
Postoperative complications
Stomal complications - stenosis, bowel necrosis, parastomal hernia, prolapse, retraction
Complications related to ureterointestinal anastomoses - leakage, stricture, pyelonephritis
80% of patients will have asymptomatic bacteriuria
Metabolic complications can occur
Mortality post radical cystectomy
Reported to be 1 to 3%
References http://www.wisegeek.org/what-is-aniline-dye.htm http://medical-dictionary.thefreedictionary.com/
phenacetin http://www.webmd.com/cancer/bladder-cancer/
cystectomy-for-bladder-cancer https://www.google.com/search?
q=ileal+conduit&hl=en&qscrl=1&rlz=1T4ADFA_enUS490US491&tbm=isch&tbo=u&source=univ&sa=X&ei=M5cNU_S-
Colwell, Goldberg, Carmel: Fecal and Urinary Diversions: Management Principles, Mosby 2009, pages 184 to 203.