Urology

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Cystectomy

Procedure: Cystectomy with ileal conduit

Indication: CA

Description: Partial cystectomy may be performed transurethrally, laparoscopic, or open. The CA is resected and removed via the surgical approach. Radical (total) cystectomy can be performed laparoscopically or open. The entire bladder is removed and a urinary diversion is created.

Post-op Implications: Complications: Intraabdominal bleeding, bright red urine can indicate this. Nerve injury can cause impotence or paralysis of BLE adducter muscles.

Meds: Restart home Rx as soon as able.

Principles: UOP should still be >30ml/hr. Pink urine is OK for first couple of days, bright red urine indicates hemorrhage.

Care Plan: Ileal conduit care (stoma, skin, and urine assessment), always have extra ostomy supplies at bedside, Wound care, strict I&O monitoring, manage IVF, Skin care, pain control, early ambulation.

Course of Care: POD#1: OOB, CL post-op and advance diet as tolerated, possibly D/C to floor first day, educate pt on ostomy care.

Room Setup: Humidified 02, oral suction, standard IV-pump, possible PCA, and, SCDs.


Nephrectomy

Procedure: Nephrectomy

Indication: Donor nephrectomy, CA

Description: Can be performed laparoscopically, robotically, or open. A flank incision, or retroperitoneal approach gains access to the kidney. The kidney is then either resected (partial nephrectomy), or completely removed, then incisions are closed.

Post-op Implications:

Complications:

  • Bleeding: observe for hgb/hct drop, flank/back pain, and hematoma around surgical area/back/flank of operative side.
  • Pneumothorax: (flank incisions have this potential regardless of procedure.).
  • Urine leak: requires drainage and sometimes ureteral stent.
  • UTI: diagnose and treat ASAP, imperative to retain function of remaining kidney.
  • Peritonitis: can be caused by perforation of duodenum or colon.
  • Acute Adrenal insufficiency (acute addisonian crisis): when all adrenal tissue is removed, hypoglycemia, hyponatremia, hyperkalemia, hypotension, hyperpigmentation, fatigue and weakness, nausea and vomiting, and abdominal pain, needs corticosteroids to treat.

Principles: Respond quickly to decreased urine output, keep well hydrated, decreased urine output can put remaining kidney tissue at risk. Treat UTI ASAP as this can put remaining kidney tissue at risk. Maintain drainage tube patency (if applicable), backup can cause hydronephrosis.

Care Plan: Wound care, strict I&O monitoring, manage IVF, Skin care, ureteral stent care (if applicable), foley care (if applicable), pain control, early ambulation.

Course of Care: POD#1: OOB, advance diet as tolerated, restart home Rx as able.

Room Setup: Humidified 02, oral suction, standard IV-pump, possible PCA, and, SCDs.