For Patients

Urology Reconstruction and Continence

The function of the bladder and the lower urinary tract is to store urine, and then to permit efficient voiding when convenient. Problems can arise with both storage and voiding, which can result in bothersome (and sometimes embarrassing) symptoms. Non-surgical treatments (e.g. drugs, physiotherapy) are often effective options, but sometimes surgery is required to provide an effective solution.

Urethroplasty (buccal patch or anastomotic)

What does the procedure involve?

Open repair of the urethra for a stricture close to the bladder

What are the alternatives to this procedure?

Observation, optical urethrotomy, repeated stretching using metal/plastic dilators

What should I expect before the procedure?

You will usually be admitted on the day of surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery. You will be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.

What happens during the procedure?

A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. You will usually be given an injectable antibiotic before the procedure after checking for any drug allergies.

An incision is made over the stricture either on the penis or in the skin between the scrotum and the anus (the perineum). The scar is either cut away and the urethra re-joined over a catheter or widened with a piece of cheek lining (buccal mucosa) over a catheter. A drain may be inserted and possibly a second catheter placed in the bladder through the lower abdomen. The wound is closed with absorbable sutures. If a graft is taken from the cheek lining, this area heals quickly and sometimes does not require any stitches.

What happens immediately after the procedure?

If a graft has been taken from the cheek lining, antiseptic and anaesthetic mouthwash will be used regularly and wide opening of the mouth is encouraged. You are allowed to eat and drink straight after the operation but it may be a few days before you are fully comfortable with doing that. The average hospital stay is 3 to 4 days. You will go home with a catheter in place and this will be left in place for 2-3 weeks (see below).

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You may experience discomfort in the mouth and restricted jaw opening if a graft has been taken from the cheek lining. You may develop a recurrent stricture requiring further surgery or other treatment – this may affect up to 20% individuals.

You may experience loss of or altered erections as a result of surgery to the urethra. Men can experience dribbling of urine post-operatively due to “bagginess” of the graft

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

There may be some discomfort from the catheter and physical activity will generally be restricted for 2-3 weeks. Jaw movements may be restricted if a graft has been taken from the cheek lining and wide opening of the mouth is encouraged.

What else should I look out for?

Any increasing pain, wound discharge or swelling should be reported to your GP immediately.

Are there any other important points?

Before the catheter is removed, an X-ray (urethrogram) will be arranged alongside the catheter in the penis, approximately 3 weeks after your operation, to ensure that the area has healed. If the X-ray is satisfactory, the catheter in the penis will be removed. If healing is not complete on the X-ray, the catheters will need to remain in place and a further X-ray will be arranged after another 2 weeks. After catheter removal, you will be followed up in the outpatient clinic after 12 weeks.

Robotic Pyeloplasty

Introduction

What is a robotic Pyeloplasty?

A robotic pyeloplasty is a minimally invasive surgical procedure to correct a blockage or narrowing (PUJ obstruction) at the junction between the kidney and the tube draining urine (ureter) down to the bladder. The surgeon uses the DaVinci robot to perform the operation.

Why is it necessary?

To correct a blockage or narrowing which can be causing a problem to your health. This could potentially cause:
• Pain
• Infection
• High Blood Pressure
• Kidney stones
• Deterioration of the kidney function

The aim of the operation is to correct the blockage and prevent the risk of further problems occurring.

To find out the cause of the problem you will have been seen in the clinic to record the details of your symptoms and to be examined. You may be required to have a CT scan (a body x-ray) to let your urologist see the blockage or narrowing.

Before your procedure

What preparation is needed?

The most important preparation is for you to understand what is being done, why it is being done and for you to feel confident to have the operation. You need to be ready for a 2-4 day stay in hospital, but this can vary depending on the individual.

You need to bear in mind that you will be up and about a day or two after the operation. A period of 4-6 weeks for convalescence is also required, at home, before you get back to your normal activities.

If you are a smoker it is helpful if you can stop a few days before you come into hospital.

A routine blood or urine test will be required with possibly a heart tracing and chest x-ray to make sure you are fit for the operation. These are normally done in the pre-admission clinic, prior to your operation.

You will come into hospital on the morning of the operation and be seen by the nursing and medical staff on the ward.

The anaesthetist will explain what will happen when you are put to sleep. Elasticated stockings will be provided to prevent clots forming in the veins of your legs. You will also be given a daily injection to slightly thin your blood.

You will change into a hospital gown and be pushed to the operating department on your bed or on a trolley. The anaesthetist will put you to sleep usually by an injection in your hand.

During your procedure

How is the operation done?

The first part of the operation is to give you an anaesthetic (put you to sleep) so that you will not be aware of anything whilst the operation is being performed.

The operation can take 3-4 hours, but can vary depending upon the individual.

Three small cuts (approximately 1cm) are made in your stomach to perform the operation. A small plastic tube (stent) is placed inside the pipe leading from the kidney (ureter) at the beginning of the operation to bridge the surgical repair and help urine to drain freely from the kidney involved.

The tube will be left inside for 4-6 weeks and you will return as a day case to have this removed. This is done under local anaesthesia through the passage where you pass urine.

A tube (catheter) is placed into your bladder to allow urine to drain whilst you recover from your operation. The urine may have blood in it but this is normal and will clear in a day or two. The tube (catheter) will be removed once you are walking around, in a day or two.

You may also have a wound drain in your stomach to drain away any blood. This will be removed when there is little or no fluid draining from it.

After your procedure

What will happen after the operation?

You will wake up in the recovery area in your bed and when the nurses are happy with your condition a nurse from the ward will come to take you back to the ward.

You will have a drip in an arm vein. This is to keep you hydrated until you are drinking properly. You will feel ‘groggy’ during the first night after your operation and may have some pain. There are painkillers, which can be given by mouth; these can be enough to stop your pain. If this is not enough to keep you comfortable, a painkiller machine (PCA) may be put up for overnight use. A nurse will show you how to press a button to release the painkiller.

You may experience minor shoulder or stomach pain for up to two days following surgery. This is due to the gas used to inflate your stomach during surgery. Patients often describe this as a ‘wind like’ pain. You may feel sickly following your operation but medication can be provided to control this.

Remember that people recover at different speeds so do not worry if you do not seem to be recovering at the same speed as others.

The day after your operation the tube (catheter) and wound drain may be removed depending on the individual. If you are comfortable and do not feel sickly you may be allowed to eat and drink.

What problems can occur?

You will experience some pain and discomfort, this will settle and painkillers are available to help reduce this. If you are relatively young and medically fit there is only a small risk that the operation and anaesthetic will affect your health in any way (less than 1 in 1000).

If you do have other health problems such as a bad chest or angina, then the risks are slightly higher, but precautions will be taken.

The urologist performing your operation will tell you that there is a very small risk of having to perform open surgery if he has difficulties.

Are there any alternatives to this surgery?

The only alternatives to this kind of surgery are conventional open options which are now rarely performed.

What can I do when I get home?

Take it easy and build up your strength gradually over 4-6 weeks. Start with short walks and gentle exercise until you are fully back to normal. Try to eat a healthy diet with plenty of fluids. Fresh fruit and vegetables are important to keep your bowels regular as this operation can make your bowels ‘lazy’ for a few days.

Avoid heavy lifting, strenuous exercise and heavy housework during this period. Once you feel that you are back to normal it is safe to do household tasks and to drive. If you work it depends on you and the type of job you do, but 4-6 weeks convalescence is recommended.

A review appointment for twelve weeks will be arranged to check on your recovery from the operation.

A 4-6 week appointment will be sent for you to have your stent removed in the Urology Investigation Suite.

If you have any problems following your discharge from hospital you can contact your GP for advice. You will be given a letter for your GP when you leave the ward. A district nurse will be asked to visit you at home to check that your stomach wounds are healing.

Further information and advice

It is very important that you are happy to go ahead with your operation. The best time to ask questions is during your clinic visit with your urologist. In the pre-admission clinic you can speak to a nurse or junior doctor who will be happy to help. The consultant or his deputy will see you when you come into hospital to answer any further questions.

Contact details

Please ring switchboard – 0191 233 6161 – and ask to be transferred to ward 1 at the Freeman.

Finally

Most peoples’ stay in hospital is straightforward and they get the result they want. We hope that this webpage gives you the information that you need. Do not hesitate to approach a nurse or doctor if you have any questions or worries.

 

Sacral nerve stimulation

Neuromodulation is a treatment for both overactive bladder syndrome and recurrent urinary retention. It involves the insertion of a type of “bladder pacemaker” and the treatment is usually an initial test phase followed by insertion of a permanent stimulator if the test phase is successful. This is a reversible treatment which is only effective during periods of stimulation.

What does the procedure involve?

This procedure involves an initial test phase to stimulate the nerves that control some aspects of bladder function – these nerves are situated in front of the sacrum (lower back). If the test is successful, at a later date a permanent lead is placed into the sacrum and attached to a permanent nerve stimulator which is inserted into the buttock area.

What are the alternatives to this procedure?

For overactive bladder symptoms: bladder re-training, physiotherapy, drug treatment, Botulinum toxin injections into the bladder, bladder enlargement or replacement using bowel, urinary diversion into a stoma. For symptoms of urine retention: permanent or intermittent catheterisation.

What should I expect before the procedure?

After attending a pre-admission clinic before your operation date you will usually be admitted on the day of your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery as a general (full) anaesthetic is necessary. You may be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.

What happens during the procedure?

Neuromodulation involves several stages of treatment. During the first admission, a temporary test electrode is placed into one of the sacral nerves in your lower back. The test electrode is connected to a device which generates electrical impulses for 7-14 days. During this time, you will be at home and will be asked to complete an input/output chart. The electrode will then be removed and the results discussed with you. If the initial test shows that the stimulation does alter bladder function, you may proceed to permanent implantation of an electrode and impulse generator.

The second admission will involve a general anaesthetic. During the surgery, a permanent electrode will be implanted into the sacral nerves in your lower back and a permanent generator will be placed in your buttock area. This is sometimes carried out in two stages with a 4 week period between them.

What happens immediately after the procedure?

Post operatively your implant will be switched on and programmed so that you obtain maximum benefit with regard to your symptoms whilst ensuring maximum comfort for you. When the implant is switched on, you will feel a tapping sensation in the genital or rectal area. For the test phase of Neuromodulation you will be connected to a device which generates electrical impulses. We will teach you how to use this device and provide you with contact details should you need any further support.

If the test lead is successful, a further admission for insertion of a permanent lead will be arranged and four weeks later for insertion of the permanent stimulator. This will then be switched off to allow healing and arrangements will be made for you to attend a further four weeks following insertion for the permanent stimulator to be activated. Your Specialist Nurse will activate and programme your stimulator for you and will also teach you how to control your stimulator. It may take several visits to get the right programme settings for your symptoms.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You will require surgery in the future to replace the stimulator as this will last on average for five years. You may require surgery in the future to replace, relocate or remove the lead or implant. You may notice an adverse effect on bowel function.

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. If you have problems however, please contact your named Specialist Nurse.

What else should I look out for?

If you experience any flu-like symptoms, redness/throbbing in the wound, pain/burning when passing urine or difficulty passing a catheter, please contact your GP. Your Specialist Nurse will maintain contact throughout your Neuromodulation treatment. Over time, the body can become conditioned (used) to the programmer settings and you may need advice on re-programming.

Are there any other important points?

Your Specialist Nurses will keep in contact with you after your discharge from hospital and you will have an outpatient review appointment within 3-6 months once your permanent Neuromodulation is activated.

Mitrofanoff procedure (catheterisable urinary stoma)

What does the procedure involve?

This is a procedure to create a channel (for catheterisation) between the skin and either the bladder or a urinary reservoir. This is likely to be done (but not always) in conjunction with another procedure (either enlarging the bladder with a bowel patch or creating a urinary reservoir). This information sheet should be read in conjunction with the relevant information sheet for any other procedure.

What are the alternatives to this procedure?

Use of a catheter via the urethra (water pipe) or a urinary stoma with a bag.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and the your named nurse. You will be asked not to eat or drink for 6 hours before surgery. You will be given an injection under the skin of a drug (tinzaparin) which, together with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins of your legs.

What happens during the procedure?

A full general anaesthetic (where you will be asleep throughout the procedure) will be used. The channel will be created using the appendix (if you still have one), a short segment of small intestine (ileum) or a combination of both. It will be joined to the skin by a flap fashioned into a small pit, rather like a second umbilicus (navel).

What happens immediately after the procedure?

You may experience discomfort for a few days after the procedure but painkillers will be given to you on the ward and, later, to take home. Absorbable stitches are normally used on the skin flap and these do not require removal. A catheter will have been inserted into the channel, together with one or two catheters into the bladder or urinary reservoir, to promote drainage and to allow the suturing to heal up completely. You will probably be able to go home, once you are mobile, with the catheters in place, having been taught how to manage them. You will be re-admitted 3 weeks after the operation for removal of these catheters and to be taught how to pass a catheter into the Mitrofanoff stoma. The average hospital stay is 2 weeks.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

The channel may become narrowed, requiring either a catheter to be left for about two weeks or, possible, further surgery to correct the problem. The channel may not hold urine without leakage, leading to further surgery to correct the problem.

Rarely, you may develop anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death).

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

It will be at least 6 weeks before full healing occurs and you may return to work when you are comfortable enough and your GP is satisfied with your progress.

What else should I look out for?

If there is any difficulty passing a catheter into the Mitrofanoff channel, please contact your named nurse. If you experience fever or vomiting, especially if associated with unexpected pain in your abdomen, you should contact your GP immediately for advice.

Are there any other important points?

A follow-up outpatient appointment will be arranged for you some 10-12 weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home.

Enlargement of the bladder using a segment of bowel (augmentation cystoplasty)

What does the procedure involve?

This involves enlargement of the bladder through a lower abdominal incision by taking an isolated segment of bowel, and forming this into a patch that is sewn into an opening made in the bladder

What are the alternatives to this procedure?

Observation, bladder training, pelvic floor exercises, drugs, injections into the bladder, urinary diversion, sacral nerve stimulation.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, your named nurse and possibly a Urology Nurse Specialist. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You will be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. Through an incision in your lower abdomen, the bladder will be opened and spilt almost in two. The two halves will then be joined together using a patch fashioned from an isolated segment of bowel and the ends of the bowel from where the segment has been taken will be re-joined.

What happens immediately after the procedure?

The average stay in hospital will last approximately 10-14 days. Two catheters will be placed in the bladder for about two to three weeks, one via the urethra and one (suprapubic catheter) via a small incision in the skin over the bladder. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach.

After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm and you may have a further drip into a vein in your neck.

You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation. It will, however, take at least 6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You may develop diarrhoea/vitamin deficiency/constipation due to shortened bowel, requiring treatment. Bowel and urine leakage from the anastomosis, requiring re-operation, can occur. Similarly you may develop scarring of the bowel or ureters requiring further surgery. There is a risk of developing recurrent urinary infections, requiring long-term antibiotic treatment.

Some patients need to self-catheterise because the enlarged bladder will be unlikely to empty fully after the procedure. The function of the kidneys may decrease with time. You may pass mucus in the urine which can cause intermittent blockage of the urinary stream.

Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) can occur at the time of surgery.

Follow-up telescopic examinations of the bladder under local anaesthetic will begin at between 5 and 10 years after surgery to check for the bladder remains healthy.

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

You will require pain-killing tablets at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile.You may go home with one or both catheters still in place, and have a planned return to hospital for these to be removed. If so, you or your carers will be taught how to look after the catheters and the drainage systems for them.

You should avoid driving for at least six weeks, and it may be longer before this is possible. If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity. Heavy lifting should be avoided for 6 weeks. Sexual intercourse should be avoided for at least a month. You may see blood in the urine or vaginal discharge for up to a month after surgery.

What else should I look out for?

If you go home with catheters, you or your carers should check regularly to ensure that urine is draining via the catheters, which confirms that the catheters have not blocked. If the catheters both become blocked this could put pressure on the suture line in the bladder, and so the catheters would need to be flushed and unblocked very promptly.

Are there any other important points?

The Urology Specialist Nurses will keep in contact by phone and by clinic visits in the first couple of months after surgery, and be available for long-term follow-up. A follow-up outpatient appointment will be arranged at about 10-12 weeks after surgery.

Re-implantation (reconstruction) of the ureter (augmentation cystoplasty)

What does the procedure involve?

This describes a number of procedures to re-establish drainage of urine into the bladder when it has been interrupted because of scarring or damage to one of the ureters (the tubes which drain urine from the kidney to the bladder)

What are the alternatives to this procedure?

Long-term drainage with a ureteric stent, nephrostomy tube (external drain), conservative management (leaving the kidney to lose its function spontaneously).

What should I expect before the procedure?

You will usually be admitted on the morning of your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery. You will also be given an injection under the skin of a drug (tinzaparin) which, along with elasticated stockings provided on the ward, will help prevent thrombosis (clots) in your leg veins.

What happens during the procedure?

A full general anaesthetic (where you are asleep throughout the procedure) will normally be used. Drainage may be re-established by a variety of means; by directly re-joining the ends of the ureter above and below the area of blockage, by re-implanting the ureter into the bladder, by fashioning a tube of bladder to reach up to the ureter above the blockage (a bladder flap), by transferring the end of the blocked ureter over to the ureter on the other side or by replacing the ureter along its whole length with a segment of intestine (bowel).

The choice of procedure will be discussed with you in detail by your Consultant. However, it is often not clear before the operation which procedure will be most appropriate for your particular problem, so a range of options are usually discussed.

What happens immediately after the procedure?

An internal drain (ureteric stent) is usually placed across the join where the blockage has been in order to allow free drainage of urine into the bladder and to avoid leakage outside the ureter. There will be a drainage tube close to the wound to drain fluid away from the internal area where the operation has been done. There is usually a catheter in the urethra (water pipe) and, possibly, an additional catheter directly into the bladder through the skin of the lower abdomen (a suprapubic catheter).

After the operation, you may spend some time in the Intensive Care Unit or in the Special Recovery area of the operating theatre before returning to the ward. You will normally have a drip in your arm and, occasionally, a further drip into a vein in your neck. You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid and food as soon as possible. We normally use elastic stockings to minimise the risk of blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time after your operation.

If you have a drain or a tube in your blocked kidney (a nephrostomy tube), this may be removed on the ward or at a later stage after your discharge. The average stay in hospital will last approximately 5-10 days.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You may develop recurrent urine infections requiring long-term antibiotics. The function of the kidney may decrease with time.

Rarely, you may develop anaesthetic or cardiovascular problems possible requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death). There may be a failure to establish good drainage requiring repeat surgery.

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

It will be at least 6 weeks before full healing occurs. You may return to work when you are comfortable enough and your GP is satisfied with your progress. It can take several months for the strength of the wound to return to normal and you should avoid heavy lifting for up to 6 months.

What else should I look out for?

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.

Are there any other important points?

An appointment will be made within 6 weeks for you to have your stent removed, generally under local anaesthetic. This will be discussed with you and arrangements made before you go home. A follow-up outpatient appointment will be arranged for you some 10-12 weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home.

Formation of ileal conduit

What does the procedure involve?

Diversion of urine to skin with an intestinal stoma

What are the alternatives to this procedure?

Catheters, bladder enlargement, continent diversion (a catheterisable pouch), depending on the reason why the stoma is being formed

What should I expect before the procedure?

You will be seen by a Stoma Nurse Specialist before your operation to discuss life with a urostomy and to try the various drainage bags available. If you wish, you will given the opportunity to meet someone who has previously had this procedure. You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse.

You will be seen by the Stoma Nurse Specialist before your operation to mark the site where your stoma will be positioned. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You will be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.

What happens during the procedure?

A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. In the operation, the ureters (the tubes which drain urine from the kidneys to the bladder) are sewn to an isolated segment of small bowel which is positioned on the surface of the abdomen as an opening called a urostomy. The ends of the small bowel, from which the conduit is isolated, are then joined together again.

What happens immediately after the procedure?

The average stay in hospital will last approximately 10-14 days. Drainage tubes will be placed through the stoma up to the kidneys, for about 8-10 days. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach.

After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm and you may have a further drip into a vein in your neck.

You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation. You or your carer will be shown by the stoma care nurse how to empty and change the stoma bags, and you or your carer will be confident doing this before you go home. It will, however, take at least 3-6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You will be at higher risk of having recurrent urinary infections after surgery, and you may require long-term antibiotic treatment. The function of the kidneys may decrease with time.

Less commonly, anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) may occur. There is a small risk of needing a blood transfusion. You may develop a hernia at the urostomy site, and this sometimes requires further surgery. You can develop diarrhoea/vitamin deficiency/constipation due to shortened bowel, requiring treatment. Scarring of the bowel or ureters requiring further surgery can occur.

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

You will require pain-killing tablets at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile. You should avoid driving for at least six weeks, and it may be longer before this is possible. If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity. Heavy lifting should be avoided for 6 weeks. Sexual intercourse should be avoided for at least a month. You may see blood in the urine or vaginal discharge for up to a month after surgery.

What else should I look out for?

There are a number of complications which may make you feel unwell and may require consultation with your GP or contact with Newcastle Urology. If you experience fever or vomiting, especially if associated with unexpected pain in the abdomen, you should contact your doctor immediately for advice.

Are there any other important points?

The Stoma Care Nurses will keep in contact by phone and by clinic visits in the first couple of months after surgery, and be available for long-term follow-up. A follow-up outpatient appointment will be arranged at about 10-12 weeks after surgery.