Dr. Sean Elliott, MD
Reconstructive Urologist
Cystectomy Pre-operative Instructions
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You may receive pre-operative instructions from the hospital with additional information. Anything in those instructions should supersede what you see here. We provide these urethroplasty-specific instructions to help with nuances about things like whether or not to stop aspirin and how we manage your urine culture findings. But the hospital-derived instructions may have more up-to-date information about non-urology aspects of your pre-operative preparation.
Pre-operative History and Physical
To make sure that your body is fit for anesthesia and surgery, our hospital requires that you have a pre-operative history and physical (a.k.a., check-up) within one month of surgery. You can schedule that with your primary care provider or, in some cases, at the anesthesia pre-op clinic at our hospital. At this visit, your provider will make sure your heart and lungs are fit for surgery and adjust medicines as needed before surgery. They may order additional testing (such as an EKG) to confirm that you are safe for surgery.
Be sure to go over all of your medicines with the person doing your pre-operative history and physical. In particular, you should have a discussion about which medicines to take the morning of surgery (it is okay to take these with a sip of water) and which can be skipped. Generally, we ask that you stop blood thinning medicines like warfarin (Coumadin), rivaroxaban (Eliquis), and clopidogrel (Plavix) but please DO NOT STOP ASPIRIN if you are taking it. Aspirin does not, in our experience, cause any problems with surgical bleeding and it is excellent at protecting against heart attack in people who need it. The exact timing of when to stop warfarin, rivaroxaban or clopidogrel vary from patient to patient so please discuss with us and/or your primary care provider.
Pre-operative Labs
You will need some bloodwork and urine testing before surgery. You can coordinate this with your pre-operative history and physical or do it in our urology clinic. A urine culture is important because we have to ensure that there is no bladder infection before we operate on your bladder. If there are bacteria in your bladder on the urine culture but you do not have any symptoms of a bladder infection then we will delay treatment of the bacteria until 3 days before surgery. In that case, you will take 3 days of antibiotics on those final 3 days so that your urine is sterile for surgery.
Pre-operative Shower
A pre-operative shower with a special soap can help prevent wound infections after surgery. Please go to your local pharmacy ahead of time and purchase a bottle of over-the-counter 4% Chlorhexidine soap (e.g., Exidine or Hibiclens) to use as instructed the night before or morning of surgery. If you cannot shower then use 2% CHS wipes (e.g., SAGE) to clean.
Bowel Preparation
We will be operating on your bowel (a.k.a., intestines) during this surgery. So, we may ask you to do a bowel prep before surgery. We do this is in a minority of cystectomy surgeries. It depends on whether we plan to make the urinary diversion out of your small intestine (no bowel prep) or large intestine (yes bowel prep).
Ileal or colon conduit: If we know for sure we can do a conduit using the ileum (which is small intestine) then we don't do a bowel prep. Sometimes, due to scar tissue or radiation damage to the ileum, we might need to be prepared to use the large intestine for the conduit (i.e., colon conduit because the large intestine is otherwise known as the colon).
Indiana pouch: This is always made out of the colon, so we always do a bowel prep.
Please double-check with our urology nurse about whether a bowel prep is required in your situation. In either case, if you rely on enemas or other techniques to have a bowel movement, it is helpful if you double the frequency of that regimen in the week before surgery so that we can avoid constipation at the time of surgery.
The bowel prep is 4L of GoLytely spread out over 2 days before surgery (2L two days before and 2L one day before). This will give you diarrhea so be sure you are near a toilet.
Diet
It is important that your stomach be empty prior to anesthesia. This helps prevent pneumonia should you throw up during surgery. The safest guideline is to eat and drink nothing for 8 hours before surgery. If you need to drink something, then you can drink clear liquids for up to two hours before surgery (but not other liquids and not solid food). Clear liquids include water, apple juice, Gatorade, black coffee, or tea without any milk or cream. Liquids should not contain alcohol.
Contact Us
University of Minnesota:
1. Nursing phone helpline at the Urology clinic (8A-5P M-F): 612-625-6401
2. Meghan Howe is Dr. Elliott's nurse in the Urology clinic. Her direct line is: 612-713-9649
3. If after hours, call the clinic line at 612-625-6401 and you will be connected with the Urology resident on call. If that fails, then call 612-273-3000 and ask to speak with the Urology resident on call.