RARC PIS

A Robotic Radical Cystectomy is a major surgery to remove the urinary bladder, usually to treat aggressive or muscle-invasive bladder cancer. Because the bladder is removed, the surgeon must create a new way for your body to store and pass urine. An Ileal Conduit (also known as a urostomy) is the most common method for this.

This procedure uses the da Vinci® Surgical System, which allows the surgeon to perform this complex reconstruction through small incisions with high precision.

Because this surgery involves both the urinary and digestive systems, preparation is more intensive than other urological procedures.

Requirement	Instruction
Stoma Marking	You will meet with a specialized WOC (Wound, Ostomy, and Continence) nurse. They will mark the best "spot" on your abdomen for the stoma to ensure it doesn't interfere with your belt line or skin folds.
Bowel Prep	Your surgeon may prescribe a "bowel prep" (laxatives) and oral antibiotics to clean out your intestines before surgery.
Diet	You may be placed on a clear liquid diet for 24 hours prior to surgery.
Medication	Stop blood thinners (Aspirin, Plavix, etc.) 7–10 days prior.

Section Summary: The key steps are clearing the bowels to prevent infection and professionally marking the stoma site to ensure your future comfort.

The surgery is performed under general anesthesia and typically takes 4 to 6 hours.

Component	Description
Removal	The entire bladder and nearby lymph nodes are removed. In men, the prostate is usually removed. In women, the uterus and ovaries may be removed.
Isolation	A short segment (approx. 15cm) of the small intestine (ileum) is isolated. The rest of the intestine is reconnected so digestion continues normally.
Connection	The ureters (tubes from the kidneys) are sewn into this isolated piece of intestine.
Stoma Creation	One end of the intestinal segment is brought out through the abdominal wall to create the stoma (spout).

Section Summary: The surgeon removes the cancerous bladder and repurposes a small piece of intestine to act as a funnel, carrying urine from the kidneys directly to a bag on your skin.

This is a significant recovery period. The average hospital stay is 5 to 7 days.

Milestone	Expectation
Bowel Function	Your bowels will "go to sleep" (ileus) after surgery. You cannot eat solid food until you pass gas.
Early Walking	Walking is the "cure" for a sleeping bowel. You will walk multiple times a day starting the morning after surgery.
Stoma Education	You will learn how to measure your stoma, cut the wafer, and change your bag. You will not be discharged until you are comfortable doing this.
Tubes	You will have small plastic tubes (stents) sticking out of your stoma to keep the ureters open. These stay in for 2–3 weeks.

Section Summary: The goal of the hospital stay is to "wake up" your bowels through walking and to master the skill of changing your urostomy bag.

Issue	Management Strategy
Mucus in Urine	This is normal. Because the conduit is made of intestine, it produces mucus. Drink plenty of water to keep it thin so it doesn't clog the bag.
Lifting Restrictions	Strictly no lifting over 10 lbs for 8 weeks. This is critical to prevent a "parastomal hernia" (a bulge around the stoma).
Hydration	Aim for 2–3 liters of water daily. Dehydration is the #1 cause of readmission.
Sleep	Connect your bag to a larger "night drainage bag" so you can sleep through the night without emptying it.

Section Summary: You must stay highly hydrated to flush out mucus and strictly avoid heavy lifting to prevent hernias around your new stoma.

Once healed, an ileal conduit is very manageable and compatible with an active lifestyle.

Aspect	What to Know
Clothing	Modern bags are flat and odor-proof. They are not visible under normal clothing.
Activity	You can swim, run, and travel. Special "stealth belts" can hold the bag secure during sports.
Diet	You generally do not need a special diet, though some foods (asparagus, fish) may cause stronger urine odor.
Vitamin B12	Over time, you may need B12 monitoring, as the section of intestine removed is responsible for absorbing this vitamin.

Section Summary: While it is a major change, most patients return to all their normal hobbies. Long-term monitoring of kidney function and vitamin levels is required.

Symptom	Potential Concern
Stoma Color Change	If the stoma turns purple, black, or blue. It should always be moist and "beefy red" (like the inside of your cheek).
No Output	No urine in the bag for more than 4 hours (and you are drinking water).
Fever > 101°F	Possible kidney infection.
Severe Abdominal Pain	Possible bowel obstruction.
Separation	If the skin pulls away from the side of the stoma.

Section Summary: The health of the stoma is vital. If it changes color (darkens) or stops producing urine, it is a medical emergency.

Even with good training, you may encounter minor issues as you get used to your urostomy. Most can be managed at home, but persistent problems require a nurse's help.

Problem	Possible Cause	Solution
Leaking Bag	Uneven skin surfaces or a hole cut too large in the wafer.	Use "stoma paste" or a "barrier ring" to fill in dips in the skin. Ensure the wafer hole is cut to the exact size of your stoma (measure it weekly as it shrinks).
Skin Irritation (Redness)	Urine trapped under the wafer or ripping the bag off too quickly.	"Crusting Technique": Dust stoma powder on the raw skin, dab with a non-sting skin barrier wipe, let dry, and then apply the bag.
Bleeding Stoma	Cleaning too vigorously.	The stoma has many blood vessels and bleeds easily. Dab gently; do not scrub. Minor spotting is normal.
Crystals on Stoma	Alkaline urine.	Drink more water and Cranberry juice (if allowed) to acidify the urine. Vinegar soaks (1 part vinegar, 3 parts water) on the stoma during bag changes can help dissolve crystals.
Strong Odour	Concentrated urine or certain foods.	Hydrate more. You can also use liquid deodorant drops specifically made for ostomy bags.

Section Summary: Leaks are usually due to fit issues—remeasure your stoma often. Red skin is treated with the "Crusting Technique." White crystals indicate you need to drink more fluids to acidify your urine.