Radical Cystectomy (Removal of the Bladder) Patients from Fox Chase Cancer Center

Continent Diversion (Indiana Pouch or Orthotopic Neobladder)

Radical cystectomy is a surgical procedure in which the bladder is removed. A continent diversion entails creating a “reservoir” by opening up loops of bowel (small or large intestine) and suturing them back together to create an internal pouch or pseudo bladder. This is now where urine is stored in the body. Depending on the type of continent diversion, the patient will get rid of urine by catheterizing a channel. The Indiana Pouch is located on their abdomen and is usually incorporated into or placed to the right of the belly button. The other type of continent diversion is the Orthotopic Neobladder and the urine is emptied via the natural urethra by either catheterizing or performing a forceful abdominal strain (aka Valsalva maneuver). This surgery involves the removal of the bladder, prostate and seminal vesicles in men and the bladder and often gynecological organs (uterus, fallopian tubes, ovaries, anterior vagina) in women. Depending on the surgeon and nature of the procedure, the appendix may or may not be removed. Pelvic lymph nodes are also removed in both cases.

Patients commonly spend 5-10 days in the hospital and are discharged with multiple tubes that help the urinary diversion drain while it heals. These tubes are critical to healing and are removed sequentially during the post-operative period.

If a cystectomy patient presents to the emergency department:

  • Please never remove or change any existing tube unless directed to do so by the attending urologic oncologist.
  • Please refrain from aggressive manipulation of the rectum, peritoneum or penis/urethra (this can disrupt some of the connections, especially the one between the neobladder and the urethra).
  • If the patient presents with a fever or signs concerning for urinary tract infection, please obtain urine and or blood cultures prior to initiating antibiotics.
  • If the patient undergoes any abdominal or other pertinent imaging, please provide the patient with a copy of the imaging report and imaging CDs.

We always greatly appreciate the care our patients receive at Emergency Departments in our region. Please never hesitate to reach out to our team with any questions/concerns/transfer requests:

Monday-Friday, 8:30 AM-5 PM, call 215-728-4300
All other times, call 215-728-6900

Incontinent Diversion (Ileal Conduit)

Radical cystectomy is a surgical procedure in which the bladder is removed. An ileal conduit urinary diversion entails creating a “conduit” out of the distal ileum (small bowel) by disconnecting a portion of the ileum, bringing it out as a stoma, and connecting the ureters to its other/internal end. The stoma will generally be brought out on the right side of the abdomen. This surgery involves the removal of the bladder, prostate and seminal vesicles in men and often the gynecological organs (uterus, fallopian tubes, ovaries, anterior vagina) in women. Depending on the surgeon and the nature of the procedure, the appendix may or may not be removed. Pelvic lymph nodes are also removed in both cases.

Patients commonly spend 5-10 days in the hospital and are discharged with stents which exit through the stoma and into the external pouch. These stents are removed in the post-operative period usually after 10-14 days.

If a cystectomy patient presents to the emergency department:

  • Please never remove or change any existing tube unless directed to do so by the attending urologic oncologist.
  • If the patient presents with a fever or signs concerning for urinary tract infection, please obtain urine and or blood cultures prior to initiating antibiotics. If a sample is required please follow the steps noted under "Directions for Obtaining a Urine Specimen From an Ileal Conduit" on the following pages.
  • If the patient undergoes any abdominal or other pertinent imaging, please provide the patient with a copy of the imaging report and imaging CDs.

We always greatly appreciate the care our patients receive at Emergency Departments in our region. Please never hesitate to reach out to our team with any questions/concerns/transfer requests:

Monday-Friday, 8:30 AM-5 PM, call 215-728-4300
All other times, call 215-728-6900

Directions for Obtaining a Urine Specimen From an Indiana Pouch

The correct procedure should be followed to avoid contamination of the urine sample. Contamination could result in incorrect culture results leading to unnecessary antibiotic use. Please note that the entire procedure may take 20-30 minutes. Collecting a sufficient amount of urine may take 5-15 minutes.

Supplies for Indiana Pouch Urine Specimen Collection

  • Urethral catheterization tray (remove betadine)
  • Sterile saline solution
  • Sterile gauze or sterile cotton balls (found in catheterization tray)
  • Sterile specimen container

Procedure for Indiana Pouch

  1. Prepare working field with urethral catheterization tray
  2. Pour sterile saline on cotton balls
  3. Put on sterile gloves
  4. Cleanse small opening of the Indiana Pouch with saline soaked cotton ball or sterile gauze
  5. Lubricate 2 inches of catheter tip with KY jelly
  6. Insert tip of catheter into stoma opening of the Indiana Pouch approximately 2/3 length of catheter
  7. Place other end of catheter into sterile collection container
  8. Wait for urine return (may take 10-15 minutes)
  9. Remove catheter

Directions for Obtaining a Urine Specimen From an Ileal Conduit

The correct procedure should be followed to avoid contamination of the urine sample. Contamination could result in incorrect culture results leading to unnecessary antibiotic use. Please note that the entire procedure may take 20-30 minutes. Collecting a sufficient amount of urine may take 5-15 minutes.

***DO NOT CATHETERIZE AN ILEAL CONDUIT FOR A URINE SPECIMEN***

Supplies for Ileal Conduit Urine Specimen Collection

  • Sterile gloves
  • Sterile gauze
  • Sterile saline
  • New ostomy pouch
  • Sterile specimen container

Procedure for Ileal Conduit

  1. Remove bag to visualize the ileal conduit stoma
    • If client has a one-piece appliance, remove and change entire appliance after cleansing stoma as outlined below
    • If client has a two-piece appliance, ensure flange (the piece adhered to patient abdomen) is wiped free of mucus prior to following the steps below
  2. Cleanse stoma using sterile gauze moistened with sterile saline using a circular motion from the stoma opening outward
  3. Place a new urostomy bag over stoma and wait for at least 20 cc to drip into bag
  4. Open spout to allow urine to run into sterile urine container
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