www.flinturology.com
Urology Services, Inc.
G-1121 West Hill Rd.
Flint, Michigan 48507
Tel: 810.232.8888
Fax: 810.232.9190
Email: jbauer@flinturology.com
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John J. Bauer, M.D.
www.flinturology.com Urology Services, Inc.
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Contents
General information
Pre-operative instructions
Risks and Complications
Detailed Surgery Description
Family waiting instructions
Post-operative instructions
Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. To print a selection, highlight the section you want to print using your mouse, then click on print, and then in the print menu, choose "selection."
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
This procedure is commonly performed for selected patients with locally infiltrative Bladder cancer, for more background information about bladder cancer please see the link at Bladder Cancer Information.
Partial or Segmental Cystectomy
Segmental cystectomy (partial removal of the bladder)—a bladder-preserving or "salvage" form of surgery—is appropriate only in a limited selection of male or female patients (for example, patients with squamous cell carcinomas or adenocarcinomas that arise high in the bladder dome). It is also offered for the patient that is highly motivated to keep his/her bladder at the very high risk of recurrence and progression. When segmental cystectomy is performed, it may be preceded by radiation therapy (see also Radiation Therapy).
Your pre-operative appointments
Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.
Change In Health Status
Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.
Pre-Operative Medication Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:
Your operation occurs near the bowels so your preparation involves an intermediate-level bowel prep, as follows.
Pre-Operative Diet Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:
Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.
Pre-Operative Cleaning Instructions (bathing and showering instructions)
Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:
On The Day Of Surgery
The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.
After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.
Time To Arrive For Your Surgery
During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.
ARRIVAL TIME:
WHERE TO ARRIVE:
The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.
Indications:
Patient presents with a high grade, invasive bladder cancer diagnosed by TURBT or any tumor found in a diverticulum or on the anterior surface near bladder neck where surveillance and repeat resection are difficult. For high grade and invasive tumors, metastatic work-up of liver function tests, CT scan of the pelvis and CXR were negative.
Alternatives:
Options include watchful waiting, chemotherapy, radiation therapy or combination, bladder sparing procedures such as radical TURBT and chemo/rads, partial cystectomy with pelvic lymph node dissection.
Risks/Complications:
The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal headache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.
The specific risks of this procedure include, but are not limited to: injury to bowel, ureter or pelvic vascular structures, injury to obturator nerve with resultant adductor palsy and gait disturbance, lymphoceole, lower extremity edema, ileus, bowel obstruction, impotence, recurrent tumor formation, failure of the procedure to cure unidentified metastatic disease, urinary tract infection, wound scarring, and positive margins or lymph nodes potentially requiring repeat partial cystectomy, radical cystectomy, adjuvant radiation or chemo therapy.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
To view the actual printable form for this surgery, click here: Counseling Note for Partial Cystectomy. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
Indications: Patient with Bladder Cancer.Sample Procedure Dictation:
Patient was given a continuous epidural anesthetic with supplemental general anesthesia. He was placed in the supine position and then was prepped and draped in the usual standard sterile fashion. A 16 French Foley catheter was placed per urethra with good return of urine; balloon was inflated to 30 cc with sterile saline. A midline incision was made from the below the umbilicus to the symphysis pubis coagulating all bleeders as the where encountered. The rectus fascia was divided the length of the incision and the space of Retsius was developed bluntly to expose the bladder and obturator fossa. The obturator lymph nodes were palpated. All nodes were normal in character and not sent for frozen section. We proceeded with obturator LN dissection, taking all nodes in the obturator fossa for permanent section analysis. This was accomplished without injury to the obturator nerve and vascular pedicle or the iliac artery and vein. All bleeders and lymphatics were bovied or clipped as they were encountered. The bladder was then entered in a vertical manner from the dome to just proximal of the bladder neck with bovie coagulation and using 0-chromic stay sutures for traction. The ureteral orifices were noted to be intact with good efflux. A 2-0 vicryl suture was placed at the apex of the incision near the bladder neck to prevent tearing the lateral wall of the bladder. The area of the bladder tumor was noted. The mucosa of the bladder was coagulated with an approximate 2 cm margin from the bladder tumor.
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The remaining bladder was noted to be uninvolved with tumor.
-------------The full thickness of bladder wall and the adventitial overlying the tumor area was removed with a scalpel. The margins were then sent for frozen section that showed no involvement with cancer. The bladder was then closed in a two-layer fashion with running 2-0 vicryl sutures. A 24 Fr three-way hematuria catheter was placed per urethra and the balloon was filled with 10 cc of normal saline. The vertical bladder incision was closed in a two-layer fashion with running 2-0 vicryl sutures. The bladder was then filled with normal saline by gravity and checked for leakage. The areas of leakage were closed with figure eight 2-0 vicryl sutures until no leakage occurred at a 350 cc volume. A 10mm Jackson-Pratt drain was placed through a separate stab incision in the pelvis. The operative site was inspected for possible bleeders, which were clipped if found. The fascia was then closed in a running fashion with #2-vicryl suture. The subcutaneous tissue was irrigated with saline and the skin was closed with staples. Xerofoam gauze was placed over the incision and bandaged. The JP drain was secured with 3-0 nylon sutures to the abdominal wall. These and the Foley were securely tapped. The Foley was set-up with CBI at a rate of 150cc/hr. The patient was then awaken from anesthesia without complications and transferred to the Recovery Room (RR) with the epidural used for pain control. The patient arrived to the RR in stable condition and without complications.
To the family and friends of patients undergoing surgery.
SCHEDULED STARTING TIME OF SURGERY:ESTIMATED LENGTH OF SURGERY:
You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.
The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.
We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.
Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.
Activity
Diet
Medication
Catheter and Wound Care
Bowel Movements
When to Contact your Doctor
Contacting Your Physician
Dr. Bauer can be contacted by calling the number listed at the top of the page. You may also call the hospital to have them contact us. Please do not hesitate to call with any questions or concerns.
Frequently Asked Questions after surgery
This section is under construction.