What does my urinary system look like?
The human urinary system normally has two kidneys, two ureters, one bladder and one urethra. The kidneys are bean shaped organs that filter your blood and remove water and waste through the urine. Connected to each kidney are narrow tubes called ureters. Ureters carry urine to the bladder. The bladder is the storage area for the urine until you are ready to urinate. The urine leaves the bladder through a narrow tube called the urethra. The female urethra passes through the vagina. The male urethra passes through the prostate gland and penis.
Radical Cystectomy with Ileal Conduit Urinary Diversion
A cystectomy is an operation to remove the bladder. In men, the bladder, prostate, seminal vesicles and lymph nodes are removed. In women, the bladder, urethra, part of the vagina and lymph nodes are removed. In addition the uterus, fallopian tubes and ovaries may be removed. An ileal conduit, also called a urostomy, redirects the urine so it drains into a bag located on the abdomen. This type of diversion will be created by removing a short segment of the small intestine (ileum) to be used as a conduit for urine to flow out of the body. The ureters will be surgically sewn to the wall of the conduit. The surgeon will close one end of the segment and then bring the open end through the abdominal wall creating a stoma.
The stoma is composed of mucus membrane of the intestine (inner lining) used to create the conduit. After surgery, it will probably be swollen and may take several months for it to shrink to its permanent size. The stoma should always be moist and red. Since the stoma does not contain any nerve endings, it is not painful.
If it is rubbed or hit, the stoma may bleed easily. This minor, temporary bleeding is normal. After surgery, a small plastic pouch will be attached to your abdomen surrrounding the stoma. There will be two small stents sticking out from the stoma that will drain urine from your ureters into the pouch. The pouch will have a spout at the bottom to drain the urine. The ET nurse will meet with you and show you how to care for your ostomy.
In summary, the kidneys produce urine, which then travels through the ureters into the newly created ileal conduit out through the stoma into a pouch to the abdomen.
GoLytely Bowel Prep for Abdominal Surgery
A "bowel prep" is done to prepare the bowel for surgery or a procedure. Its purpose is to clear out the bowel of all solid matter. Begin the bowel prep one day before your scheduled surgery.
You will need these items from a pharmacy:
On the Day Before Your Surgery
Day of Surgery
Take medicines the day of surgery, as prescribed by your doctor, with small sips of water.
Bring all your medicines with you (in the original containers) when you come to the hospital.
When you arrive for your surgery, you and your family should report to the:
Medicines You Must Stop Taking Before Surgery
These medicines must be stopped 7-10 days before surgery. Check with your surgeon:
These medicinies must be stopped 5-14 days before surgery. Check with your surgeon:
Once your surgery is finished, you will be moved to the Post Anesthesia Care Unit (PACU) for 1 to 2 hours. Your doctor will decide if you need to transfer to the Surgical Intensive Care Unit (SICU) or a hospital room. You will be connected to monitors, drains and tubes. The following is a list of what to expect after surgery.
Enterostomal Therapy (ET) Nurse
This is a nurse who specializes in the care of patients with urinary diversions. The ET nurse will teach you and your family about the care and management of your urostomy before you leave the hospital. You will meet with the ET nurse on the day of surgery and they will mark your abdomen for stoma placement. The ET nurse will visit you during your hospital stay and use hands-on teaching and videos to help you learn how to care for your new urostomy
Patient Care Resource Manager
Before you go home from the hospital you will meet with a Patient Care Resource Manager (PCRM). This member of your health care team will work with you and your family to assist with any needs you may have when you are discharged. Once you are home, you or your family should contact the PCRM if you have any additional needs or questions regarding your care.
You may need a home health nurse, medical equipment or moved to a Skilled Nursing Facility (SNF) when you are discharged. If this is the case, your PCRM will work with your doctor and other members of the team to arrange what you need.
Your nurse will give you the following information when you are discharged from the hospital.
Herbal Use Before Surgery
It has been shown that taking some herbal remedies may cause complications for people having surgery. Use of a small amount of herbs to season food is not a problem. The American Society of Anesthesiologists lists the use of herbs and remedies that could cause problems. Some of these herbs are known by other names. Read the package labels carefully. Here is the list:
What Should You Do Before Surgery?
To be safe, talk with your doctor, surgeon and nurse about all herbals and remedies you use. Tell them how often and how much you take when you have your exam before surgery.
Studies are being done to learn more about how herbs and other remedies affect bleeding and anesthesia. Much is not known. Some herbs may change or lengthen the effects of medicines used with anesthesia. Others may affect bleeding or clotting. Some can change blood pressure or interact with medicines used during surgery. In some cases the effects may be slight but still important for the anesthesiologist and doctor to know about.
In many cases it is best to stop taking herbal remedies at least 2 to 3 weeks before surgery. Anesthesiologists here at OSUMC support this advice. The anesthesiologist is the doctor who balances the medicines that keep you safely in a very deep sleep for surgery. If it happens that you do not have enough time to stop taking herbs or remedies in advance of your surgery, bring them with you to show the doctor. Bring the products in their original bottle or container. This way the anesthesiologist can read what they contain and see how much you take.
Talking openly with the doctor about all herbal remedies and health practices before you have surgery is very important. This helps keep you safe.
Bladder Cancer Websites
Bladder Cancer Advocacy Network
American Bladder Cancer Society
Bladder Cancer WebCafe
National Comprehensive Cancer Center Network
Arthur G James Cancer Hospital and Richard J Solove Research Institute
http://cancer.osu.edu/ (The James) 800-293-5066
American Cancer Society (ACS)
www.cancer.org Ohio: 888-ACS-OHIO
United Ostomy Associations of America Inc (UOAA)
The Phoenix Magazine
Medical Identification Bracelet
It is important for you to purchase a medical identification bracelet. In an emergency, this bracelet will let doctors and nurses know that your bladder has been surgically removed and a new one made. It should be worn at all times. The bracelet shoud have the following words printed on it.
"I have a urostomy pouch worn on my abdomen."
You can purchase a bracelet at any of the following locations:
American Medical ID
Medic ID International