Bladder Surgery

  1. General information
    1. Cystectomy (removal of the urinary bladder) with one of the various types of urinary diversions is the surgical procedure done for bladder cancer
    2. Types of urinary diversions
      1. Ureterosigmoidostomy: ureters are excised from the bladder and implanted into sigmoid colon; urine flows through the colon and is excreted via the rectum
      2. Ileal conduit: ureters are implanted into a segment of the ileum that has been resected from the intestinal tract with formation of an abdominal stoma; most common type of urinary diversion
      3. Cutaneous ureterostomy: ureters are excised from the bladder and brought through abdominal wall with creation of a stoma
      4. Nephrostomy: insertion of a catheter into the renal pelvis via an incision into the flank or by percutaneous catheter placement into the kidney
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Assess client's ability to learn prior to starting a teaching program.
    3. Discuss social aspects of living with a stoma (sexuality, changes in body image).
    4. Assess understanding and emotional response of client/significant others.
    5. Perform pre-op bowel preparation for procedures involving the ileum or colon.
    6. Inform client of post-op procedures.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Maintain integrity of the stoma.
      1. Monitor for and report signs of impaired stomal healing (pale, dark red, or blue-black color; increased stomal height, edema, bleeding).
      2. Maintain stomal circulation by using properly fitted faceplate.
      3. Monitor for signs and symptoms of stomal obstruction (sudden decrease in urine output, increased abdominal tenderness and distension).
    3. Prevent skin irritation and breakdown.
      1. Inspect skin areas for signs of breakdown daily.
      2. Patch test all adhesives, sprays, and skin barriers before use.
      3. Change appliance only when necessary and when production of urine is slowest (early morning).
      4. Place wick (rolled gauze pad) on stomal opening when appliance is off.
      5. Cleanse peristomal skin with mild soap and water.
      6. Remove alkaline encrustations by applying vinegar and water solution to peristomal area.
      7. Implement measures to maintain urine acidity (acid-ash foods, vitamin C therapy, omission of milk/dairy products).
    4. Provide care for the client with an NG tube (see Nasogastric (NG) Tubes); will be in place until bowel motility returns.
    5. Assist client to identify strengths and qualities that have a positive effect on self-concept.
    6. Provide client teaching and discharge planning concerning
      1. Maintenance of stomal/peristomal skin integrity
      2. Proper application of appliance
      3. Recommended method of cleaning reusable ostomy equipment (manufacturer's recommendations)
      4. Information regarding prevention of UTIs (adequate fluids; empty pouch when half full; change to bedside collection bag at night)
      5. Control of odor (adequate fluids; avoid foods with strong odor; place small amount of vinegar or deodorizer in pouch)
      6. Reporting signs and symptoms of UTIs (see Cystitis).