Ileal Conduit / Urinary Diversion
Indications:
- Cystectomy for cancer
- Irradiated bladder with hemorrhagic cystitis that is not managed well with endoscopic procedures
- Neurogenic bladders with vesical-ureteric reflux
- Chronic bladder pain
Robotic Assisted Radical Cysto-prostatectomy with Ileal Conduit or Neobladder
Indications in men:
- Muscle invasive urothelial cancer
- Squamous carcinoma bladder
- Adenocarcinoma bladder
I don’t perform this operation, and you will be referred to a high-volume surgeon in a larger institution.
Robotic Assisted Radical Cystectomy with Ileal Conduit / Neobladder
Indications:
- Muscle invasive urothelial cancer
- Squamous carcinoma bladder
- Adenocarcinoma bladder
I don’t perform this operation, and you will be referred to a high-volume surgeon in a larger institution.
Flexible Cystoscopy with Urethral Dilatation
A diagnostic day procedure under local anesthetic, where a flexible cystoscope is placed in the bladder via the urethra
Why is it done?
To investigate:
- Hematuria (blood in the urine)
- Recurrent urinary tract infections
- Space occupying lesions in the kidneys, ureters, bladder and urethra
- Abnormal cells suggestive of urothelial carcinoma, on urine cytology
- Possible urethral stricture
How is it done?
- A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and saline
- If a narrowing is found, a guidewire will be placed and urethra dilated
- The bladder is then distended using the fluid
- The inside of the bladder is viewed for pathology.
- If any suspicious lesions are seen, a biopsy will be taken.
- Urine would have been sent for cytology prior to the procedure, to rule out the existence of cancer.
- Antibiotics may be given to prevent infection
What to expect after the procedure?
- An indwelling catheter will be placed for 3 days
- Bladder infection ranging from a burning sensation to, fever, to puss (rare)
- Blood stained urine
- Lower abdominal discomfort which will persist for a few days
- NB! Each person is unique and for this reason symptoms vary.
What next?
- This all depends on what is found during the procedure. All the options will be discussed in detail.
- With the removal of stents, the ureters have been dilated and will regain function (peristalsis) as soon as the stents are out. Thus slight pain can be expected in the first 24-48hrs.
- Urethral strictures with an IDC will require a trial of void 3 days later
- There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
Urethral Dilatation
- If you have a urethral stricture, a guidewire will be placed and the narrowing dilated
- There may be some hemorrhaging and you may need a catheter for 3 days
- This will be removed at the hospital in 3 days or alternatively arrange for your GP to remove.
- I will review in 6 –8 weeks
Bladder Diverticulectomy – Robotic-assited
Open excision of bladder diverticulum. Controversial procedure for the excision of a bladder diverticulum where there is bladder calculus and bladder function is compromised/
Why is it done?
- This procedure is performed when all other treatment options are exhausted with recurrent symptoms.
- Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, sudden cut-off of stream, (LUTS), recurrent bladder infections, recurrent bladder calculi (stones).
- Medication such as Flomaxtra, Urorec or Minipress etc. should always be given as a first resort.
- Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar and can be used as a first line in these huge prostates.
- A TURP may have been performed to dis-obstruct a huge prostate.
- Neurogenic causes of bladder dysfunction should be excluded by means of a Urodynamic study.
- Patient informed decision is vital.
- It provides a quicker solution with more marked side-effects and risks.
How is it done?
Patients will receive a general anaesthesia, unless contra-indicated.- Prophylactic anti-biotics is given.
- An indwelling catheter is placed, and the bladder is filled with saline.
- Robotic access with 6 port placements.
- The retropubic space of Retzuis is entered.
- The bladder is opened anteriorly in the midline.
- A Foleys catheter is placed in the diverticulum.
- The bladder incision is extended to the diverticulum. Diverticulum is excised.
- Special care is required for diverticula close to the ureters. Placement of ureteric catheters are done to prevent ureteric injury.
- Bladder is closed in 2 layers over a 3-way irrigation catheter.
- A drain is left for a couple of days.
- You may have continuous Antibiotics over the next few days.
What next?
- You will spend 2-3 nights in hospital.
- You will have a catheter for 14 days.
- A drain for 1 -2 days.
- You will be discharged as soon as you are drain free, temperature free and have opened your bowels.
- You may initially suffer from urge symptoms caused by the catheter.
- There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
- A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
- A follow-up appointment will be scheduled for 2 weeks for a cystogram.
- Should the cystogram confirm to urine leaks, your catheter will be removed.
- A review appointment is scheduled 6 weeks later.
- Don’t hesitate to ask Jo if you have any queries.
- DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!
Side–effects
- Rarely blood loss requiring blood transfusion.
- Infection.
- Prolonged hospital stays.
- Urine leak requiring prolonged catheterization.
- NB! Each person is unique and for this reason symptoms vary!
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Bladder Fistulectomy
Why is it done?
- Bladder intestinal fistula is an abnormal communication between bladder and bowel.
- Causes:
- Previous surgery
- Diverticular disease
- Colonic cancers
- Radiation
- This procedure is performed when all other treatment options are exhausted with recurrent symptoms and persistent pneumaturia and fecal uria due to a colonic-vesical fistula
- Symptoms include:
- pneumaturia (air in urine),
- fecal Uria (stool in Urine),
- recurrent bladder infections.
- This surgery is usually done with a colo-rectal surgeon and may involve a partial bowel resection, possibly a temporary loop ileo/colostomy (diversion of bowel with an external bag)
How is it done?
- Patients will receive a general anaesthesia, unless contra-indicated.
- Prophylactic antibiotics are given.
- An indwelling catheter is placed, and the bladder is filled with saline.
- Open procedure or robotic assisted.
- A lower midline incision is made, or robotic ports are placed
- The retropubic space of Retzuis is entered
- The bladder is resected away from the bowel.
- The affected piece of bowel may be resected with either a temporary diversion of the bowel to a bag or a primary anastomosis depending on the colo-rectal surgeon’s findings
- The affected part of the bladder may be resected. The bladder is closed in 2 layers over a 3-way irrigation catheter
- Omentum will be placed between bladder and bowel where at all possible to limit recurrences
- A drain is left for a couple of days
- You may have continuous Antibiotics over the next few days.
- You have a few days stay in ICU or high care facility
Complications
Side–effects
- Rarely blood loss requiring a blood transfusion.
- Infection/ sepsis
- Prolonged hospital stays.
- Urine leak requiring prolonged catheterization.
- Bowel leak etc.
- NB! Each person is unique and for this reason symptoms vary!
Download Information Sheet
Copyright 2019 Dr. Jo Schoeman
Conduitoscopy, Retrograde Pyelogram, Stent Management
A diagnostic procedure under general anesthetic where a rigid / flexible cystoscope is placed in your ileal conduit (stoma), ureteric catheters are placed to enable imaging of the upper tracts with/without insertion or removal of ureteric stents.
Why is it done?
To investigate:
- Hematuria (blood in the urine)
- Recurrent upper urinary tract infections
- Space occupying lesions in the kidneys and ureters
- Abnormal cells suggestive of urothelial carcinoma, on urine cytology
- Surveillance of previous bladder cancer
Risk factors:
- Previous bladder cancer
- Upper tract urothelial carcinoma
- Ureteric structuring
- Stone disease
How is it done?
- This is done under General anesthesia.
- A cystoscopy is performed by placing a camera in the conduit
- The conduit is then distended with saline.
- The inside of the conduit is viewed for pathology.
- A retrograde pyelogram is done at the same time, (placement of small silicone catheters up the kidney pipes). Through this iodine contrast is injected up into the kidney collecting systems. This facilitates the viewing of kidney pipes and kidney collecting systems on X-ray to exclude any upper tract pathology.
- If any abnormalities are found in the kidney/ ureters, a flexible ureteroscopy (which is the placement of a long thin camera up the ureter) will be performed.
- If any suspicious lesions are seen, a biopsy will be taken.
- A ureteric stent may be placed
- Urine would have been sent for cytology, to rule out the existence of cancer.
- Antibiotics may be given to prevent infection.
What to expect after the procedure?
- Pain on initial passing of urine
- Infection ranging from a burning sensation to, fever, to puss (rare)
- Bloodstained urine
- Lower abdominal discomfort which will persist for a few days
- Pain radiating from bladder to renal angle associated with urinating.
- An infection could present with a stent being present.
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Copyright 2019 Dr Jo Schoeman
Cysto-Lithopaxy
Endoscopic procedure used for breaking up a bladder stone. Either with a stone crusher or laser
Why is it done?
- To break up a bladder calculus (stone).
Risk factors:
- Bladder outflow obstruction.
- BPH with chronic retention.
- Urethral stricture.
- Neurogenic bladder.
- Renal calculi disease.
- Metabolic disorders.
- Malnutrition.
- Chronic infections.
- Foreign objects in bladder.
How is it done?
- A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate (fluid).
- The bladder is then distended with fluid (saline).
- The inside of the bladder is viewed for pathology.
- If any suspicious lesions are seen, a biopsy will be taken.
- Stone crushing is attempted with a lithotrite (a crushing device).
- If the calculus is too large, laser will be utilized to fragment the stone and the smaller stones evacuated.
- Antibiotics may be given to prevent infection.
What to expect after the procedure?
- Hematuria (blood in your urine)
- You will have a n indwelling catheter (IDC), which will remain in your bladder until your urine is clear.
- You may have a continuous bladder irrigation with Saline to help clear the bleeding.
- Pain on initial passing of urine when the catheter is removed.
- Bladder infection ranging from a burning sensation to, fever, to pus (rare).
- Lower abdominal discomfort which will persist for a few days.
- NB! Each person is unique and for this reason symptoms vary.
What next?
- This all depends on what is found during the procedure. All the options will be discussed in detail.
- You may require further attention to your prostate or bladder outlet to prevent further stone formation.
- There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
- Patients should schedule a follow-up appointment within 1 month to discuss the etiology of the calculus as well as what other procedures may be involved to prevent this from occurring again.
- Please don’t hesitate to direct all further queries to Dr Schoeman.
Download Information Sheet
Flexible Cystoscopy
An atraumatic endoscopic procedure to view the bladder. Under local or sedation
A diagnostic day procedure under local anaesthetic, where a flexible cystoscope is placed in the bladder via the urethra.
Why is it done?
To investigate:
- Haematuria (blood in the urine).
- Recurrent urinary tract infections.
- Space occupying lesions in the kidneys, ureters and bladder.
- Abnormal cells suggestive of urothelial carcinoma, on urine cytology.
Risk factors:
- Strong family history of bladder cancer.
- Smokers or passive smokers.
- Factory workers: dyes, paints, etc.
- Exposure to Schistosoma (Bilharzia).
- Renal stone disease, bladder stones.
How is it done?
- A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and saline.
- The bladder is then distended using the fluid.
- The inside of the bladder is viewed for pathology.
- If any suspicious lesions are seen, a biopsy will be taken.
- Urine would have been sent for cytology prior to the procedure, to rule out the existence of cancer.
- Antibiotics may be given to prevent infection.
What to expect after the procedure?
- Pain on initial passing of urine.
- Bladder infection ranging from a burning sensation to, fever, to puss (rare).
- Blood stained urine.
- Lower abdominal discomfort which will persist for a few days.
- NB! Each person is unique and for this reason symptoms vary.
What next?
- This all depends on what is found during the procedure. All the options will be discussed in detail.
- With the removal of stents, the ureters have been dilated and will regain function (peristalsis) as soon as the stents are out. Thus slight pain can be expected in the first 24-48hrs.
- There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
- A ward prescription will be issued to patients on discharge, for own collection at any pharmacy.
- Patients should schedule a follow-up appointment within 7 days.
- Please don’t hesitate to direct all further queries to Jo.
- REMEMBER: THOSE WHO SUFFER IN SILENCE, SUFFER ALONE!
Download Information Sheet