What is a cystectomy with continent reservoir?

A cystectomy is surgery to remove part or all of your bladder. Sometimes other organs, lymph nodes, and part of the urethra are also removed. The urethra is a tube that carries urine from your bladder to outside your body.

To do the surgery, your doctor makes a cut in your lower belly. This cut is called an incision. If the doctor takes out all of your bladder, he or she will need to make a new way for you to pass urine. This is called a continent reservoir. It's a storage pouch that attaches inside your pelvis. It's made from a piece of your bowel. There are two types.

• A bladder substitution reservoir is used if your urethra is not removed. It's also called a neobladder. One end connects to your ureters. These are the tubes that carry urine from the kidneys to the bladder. The other connects to your urethra. With this type, you can urinate much as you did before surgery.
• A continent diversion reservoir with stoma is used if all or part of your urethra is removed. It's also called a urostomy. One end connects to your ureters. The other connects to an opening the doctor makes in your belly. This opening is called a stoma. When you want to urinate, you put a thin plastic tube through the stoma. The tube is called a catheter.

In the hospital, a nurse with special training will teach you how to care for your reservoir. Most people go home in 1 to 2 weeks. But you will probably need 6 to 8 weeks to get back to your usual routine. If your surgery was done to treat bladder cancer, you may need other treatments. These include chemotherapy and radiation therapy.

Surgery to remove your bladder may affect your sexual or reproductive life. But if a woman also has her uterus and ovaries removed, she will not be able to get pregnant. She could also start menopause and have hot flashes or other symptoms of menopause. And if a man has his prostate gland and seminal vesicles removed, he may have problems getting an erection. He will also not be able to get a woman pregnant. If you are a man who may want to father a child in the future, talk to your doctor. There are ways to save your sperm before the surgery.

It's common to feel sad or worried about how this surgery will affect you. It may help to join a support group. You can ask your doctor about these groups. You can also call the Canadian Cancer Society (1-888-939-3333) for more information. Or you can visit its website at www.cancer.ca.

What happens before surgery?

Preparing for surgery

• Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
• 
  Tell your doctors ALL the medicines and natural health products you take, including any vitamins and supplements. Some of these can increase the risk of bleeding or interact with anesthesia.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
• Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

What happens on the day of surgery?

• 
  Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewellery and piercings. And take out contact lenses, if you wear them.
• Leave all your valuables at home.

At the hospital or surgery centre

• 
  Bring a picture ID.
• Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery is often marked to make sure there are no errors.
• A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 3 to 6 hours.
• As you wake up in the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.
• You may have a thin plastic tube coming out of your urethra. This is used to drain fluids that can build up in the pelvis after surgery. It will be removed in a few days.
• If you have a continent diversion reservoir with stoma, you may have a small plastic tube coming out of your stoma. It helps drain urine into a small bag until your new bladder heals. An ostomy nurse or other health care professional will teach you how to care for your skin and stoma.
• If you have a neobladder, you may have drains in your belly for extra fluids. You may have catheters coming out of your belly and your urethra to drain urine from your new bladder into small plastic bags.

Going home

• 
  Be sure you have someone to drive you home.
• For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
• Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
• You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.