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time. Some people, however, will take longer for their
bowel function to return and may require intravenous
nutrition (called total parenteral nutrition). In the weeks
Total parenteral
nutrition
before surgery, it is very important to pay close attention
An intravenous form
to nutrition. Many patients benefit from protein shakes
of nutrition that pro-
and other nutritional supplements.
vides all essential
nutrients.
Finally, there is the potential for complications further
down the road. Most of these relate to the bladder
substitute; thus, we discuss them in more detail when
we go over each option.
72. What is a pelvic lymph node dissection?
A pelvic lymph node dissection is a procedure that
removes those lymph nodes that are most likely to
harbor metastatic bladder cancer. The lymphatic sys-
tem collects fluid throughout the body and returns it
to the bloodstream through its own set of tiny chan-
nels. Cancer cells often escape the bladder through
these channels and establish sites of metastasis in the
lymph nodes. If these lymph nodes are the only sites of
metastasis, then we may be able to cure some patients
of their bladder cancer by removing the lymph nodes
in addition to the bladder and surrounding structures
(radical cystectomy). Removal of these lymph nodes also
gives us important information to help direct any future
treatments that may be necessary.
73. What are the risks of a pelvic lymph
Morbidity
Unhealthy results node dissection?
and complications
In most cases, pelvic lymph node dissection does not
resulting from
treatment. increase the morbidity of a radical cystectomy operation.
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This means that people who have a radical cystectomy
with a pelvic lymph node dissection have the same out-
comes from surgery as do those patients without the
pelvic lymph node dissection. Rarely, a patient may
develop a lymphocele. A lymphocele is a collection Lymphocele
of lymph fluid that is normally drained through the lym- A collection of lymph
fluid in an area of the
phatic system. If this is very large or if it becomes
body.
infected, then it may need to be drained.
Very rarely, a nerve may be injured during the lymph
node dissection. A nerve called the obturator nerve is
most at risk during this procedure. The obturator nerve Obturator nerve
supplies some of the muscles of the thigh, often called A nerve located on
the pelvis that
the  tailor s muscles because they are necessary when
produces motor
using the foot pedal of a sewing machine. Today, these
innervation to mus-
cles in the thigh and
muscles are used most often while driving an automo-
skin sensation to the
bile to move the foot from the accelerator to the brake.
inner thigh.
Finally, there is always a theoretical risk of injury to an
artery or vein during the procedure. The pelvic lymph
nodes are wrapped tightly around the arteries and veins
and must be carefully removed. Although injury to
these vessels does occur, it should be easily repaired
during the surgery.
74. How long will it take to recover from
a radical cystectomy?
Radical cystectomy with the creation of a urinary
diversion is a major surgical procedure. It takes several
hours to perform the procedure and includes operating
on the intestines. The recovery from this surgery can
Nasogastric tube
be expected to take much longer than shorter or less
A tube placed
complicated procedures. Immediately after surgery on through the nose
down the esophagus
the intestines, their function is often not normal. It usu-
into the stomach to
ally takes several days for bowel function to return. Dur-
drain fluid accumu-
lating in the stomach.
ing this time, many surgeons place a nasogastric tube
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to drain the fluid that would otherwise accumulate in
the stomach and cause vomiting. The tube can usually
be removed as soon as bowel function returns. The
normal passing of gas best indicates the return of func-
tion. Once bowel function returns, a progressive diet
will be tried. Clear liquids such as water, apple juice,
Jell-O, or broth will be tried first. If these are well tol-
erated without nausea or vomiting, then about a day
later solid food can begin again.
About a day or two after surgery, the nurses will help
you to get out of bed, first to a chair but soon after to
walk in the hallways. Pain control will be provided
with intravenous medication until you are able to eat;
then the intravenous medications will be stopped and
Oral oral pain pills will begin. You will be ready to go home
Taken by mouth.
when your pain is well controlled with only pills, you
are able to walk on your own power at least from bed
to the bathroom, and you can tolerate regular food.
This usually takes 5 to 10 days if all goes well.
Some people, particularly those who are older or who
have multiple other medical problems, may need to go
to a rehabilitation facility after the hospital instead of
returning directly home. This is to allow for physical
therapy or nursing care that could not be provided at
home. Once the patient s strength and healing has pro-
gressed sufficiently, he or she can then return home.
When at home, expect good days and bad days rather
than a steady gain each day. You will initially tire very
easily, and you may nap during the day more than usual.
Your body is using a huge amount of your energy to
repair itself after surgery, leaving little for your daily
routine. For several weeks after surgery, you should not
lift anything more than 5 to 10 pounds or do anything
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too stressful until the muscles and connective tissues
have fully healed. It usually takes at least a month for
your full energy to return.
Once you are completely healed, you will be able to
resume virtually all of your prior activities. This usually
takes about a month. Active patients who jogged,
played tennis, golfed, skied, or participated in almost
any other activity before surgery should be able to
resume these activities in time. If you have a urostomy Urostomy bag
bag that you worry could become dislodged, then plac- A specialized collect-
ing device that is
ing a loose binder around the abdomen can provide
applied to the
some relief of the concern. Before surgery, your doctor
urostomy stoma that
collects urine.
and/or an ostomy nurse will help choose a site on your
abdomen for the stoma that will allow for easy access and
Stoma
optimal concealment. Those patients with a neobladder
A surgically created
opening in the skin
will initially find that they need to urinate frequently
for elimination of
to prevent leakage. Over time, the neobladder stretches
body waste, such as
to accommodate larger amounts of urine, allowing longer
urine or stool.
times between voids.
75. How will having my bladder removed
affect my sexual function as a man?
In males, in addition to removal of the bladder, the pro-
cedure includes removal of the prostate and seminal vesi-
cles. The portion of the procedure involving the prostate
and seminal vesicles is essentially identical to that per-
formed during a radical prostatectomy for prostate cancer. [ Pobierz całość w formacie PDF ]