Nurse's 3-Minute Clinical Reference

ISBN: 1-58255-670-9 | 2nd_Edition

(Print pagebreak 644)

Cystectomy

Overview
Partial or total removal of the urinary bladder and surrounding structures (see Types of cystectomy)

Total cystectomy: necessitates permanent urinary diversion into an ileal or colonic conduit

Indications

Advanced bladder cancer

Bladder disorders such as interstitial cystitis

Frequent recurrence of widespread papillary tumors not responding to endoscopic or chemotherapeutic management

Procedure
Partial cystectomy

The surgeon makes a midline low or transverse incision from the umbilicus to the symphysis pubis.

The bladder is opened and the tumor removed, along with a small portion of healthy tissue.

The wound is closed, leaving a Penrose drain and suprapubic catheter in place

total (Simple) cystectomy

The surgeon makes a midline abdominal incision.

The entire bladder is removed, leaving only a portion of the urethra.

Radical cystectomy

In addition to the bladder, the seminal vesicles and prostate in male patients and the uterus, ovaries, fallopian tubes, and
anterior vagina in female patients are removed.

Depending on the extent of cancer, the urethra and surrounding lymph nodes also may be removed.

To complete a total or radical cystectomy

Urinary diversion is done by attaching the ureters to an external collection device, such as a cutaneous ureterostomy, conduit
of the large or small bowel, or continent urinary neobladder.

Complications

Bleeding

Hypotension

Nerve injury, such as to the genitofemoral or peroneal nerve

Anuria

Stoma stenosis

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 Nurse's 3-Minute Clinical Reference
ISBN: 1-58255-670-9 | 2nd_Edition

Urinary tract infection

Pouch leakage

Electrolyte imbalances

Ureteroileal junction stenosis

Vascular compromise

Loss of sexual or reproductive function

Psychological problems relating to changes in body image

Types of Cystectomy
In cystectomy, surgery may be partial, simple, or radical.

Partial cystectomy involves resection of a portion of the bladder wall. Commonly preserving bladder function, this
surgery is most often indicated for a single, easily accessible bladder tumor.

Total or simple cystectomy involves resection of the entire bladder. It's indicated for benign conditions limited to the
bladder. It may also be performed as a palliative measure, such as to stop bleeding, when cancer isn't curable.

Radical cystectomy is generally indicated for muscle-invasive primary bladder carcinoma. Besides removing the
bladder, this procedure removes several surrounding structures. This extensive surgery typically causes impotence in
men and sterility in women.

After removal of the entire bladder, the patient requires a permanent urinary diversion, such as an ileal conduit or a continent
urinary pouch.

Nursing Interventions
Pretreatment care

Explain the treatment and preparation to the patient and family.

Make sure the patient has signed an appropriate consent form.

Arrange for a visit by an enterostomal therapist.

Address the patient's concerns about inevitable loss of sexual or reproductive function.

Explain the equipment the patient will see immediately after surgery.

If possible, arrange for the patient to visit the intensive care unit.

Perform standard bowel preparation, as ordered.

Administer enemas or oral polyethylene glycol-electrolyte solution, as ordered.

Administer antibiotics, as ordered.

Posttreatment care

Administer medications, as ordered.

Report urine output of less than 30ml/hour.

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 Nurse's 3-Minute Clinical Reference
ISBN: 1-58255-670-9 | 2nd_Edition

Maintain patency of the indwelling urinary catheter or stoma as appropriate, and irrigate, as ordered.

Test all drainage from the nasogastric tube, abdominal drains, indwelling urinary catheter, and urine collection appliance for
blood; notify the physician of positive findings.

Change abdominal dressings, maintaining asepsis.

Encourage frequent position changes, coughing, deep breathing, and early ambulation.

Offer emotional support.

Monitoring

Vital signs

Intake and output

Surgical wound and dressings

Drainage

Hypovolemic shock

Stoma (if present)

Frank hematuria and clots

Respiratory status

Infection

Patient teaching

Be sure to cover:

medication administration, dosage, and possible adverse effects

signs and symptoms of infection

abnormal bleeding, including persistent hematuria

complications

when to notify the physician

urinary diversion care

home care nursing visits, if appropriate

possibility of cancer recurrence

follow-up care

referral to a support group such as the United Ostomy Association if appropriate

referral for psychological and sexual counseling as appropriate.

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