A comprehensive preoperative counselling and education program to enhance post-operative recovery on patients after radical cystectomy and ileal conduit.

Abstract Description

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Authors (including presenting author) :

Ng SL(1), Ng PH(2), Lai TCT(3) Ma WK(4), TSU JHL(5)

Affiliation :

(1)Urology Nurse Consultant, Urology Division, Department of Surgery, Queen Mary Hospital, Hong Know West Cluster, (2) Specialist Nurse, Urology Division, Department of Surgery, Queen Mary Hospital, Hong Kong West Cluster, (3) Associate Consultant, Urology Department, Department of Surgery, Kwong Wah Hospital, (4) Urologist Consultant, Urology Division, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, (5) Chief and Urologist Consultant, Urology Division, Department of Surgery, The University of Hong Kong.

Introduction :

Bladder cancer is a malignant neoplasm affecting the lining of urinary bladder. It is the nineteenth commonest cancer, and, it is the sixteen leading cause of cancer deaths in Hong Kong. According to the information from Hong Kong Department of Health cited in 2015, the prevalence of bladder cancer in male to female ratio was about 2.8 to 1. Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. In the past, patients after radical cystectomy and ileal conduit had to stay in hospital for more than 2 weeks before they can go home. In order to enhance the postoperative recovery, a comprehensive preoperative counselling and education will be provided to both patient and his / her significant others at least 3 weeks before surgery.

Objectives :

By providing a comprehensive preoperative counselling and education to enhance patient recovery process during hospitalization.

Methodology :

The urology nurse specialist provides the preoperative counselling and education including (1) detailed explanation on how would the operation being done; (2) application of an urostomy bag over patient’s right lower abdomen for trial; (3) introduce an ex-patient had radical cystectomy and ileal conduit done to share his/her current condition after surgery; and (4) provide information on the stoma association for mutual support among the patients’ support group. A video demonstrating on how to self-care the ileal conduit at home would be shown to patient and family for reference peri-operatively. In addition, the patient scheduled for radical cystectomy and ileal conduit should be referred to dietitian for optimizing the nutritional status before surgery. A hotline is provided to patient for any enquiry during office hour.

Result & Outcome :

From January 2017 till September 2018, we had 24 patients undergone radical cystectomy and ileal conduit in our hospital. 16 males and 8 females, mean age at 67. About 91.7% patients were discharged from hospital on post op day 7- 8. As compared with the past, patients required to stay in hospital for at least 14 days. The program significantly diminished the hospital stay. However, there were 2 patients (8.3%) required to stay in hospital for more than 14 days due to post-operative ileus and placement problem. All patients have regular followed up at urology nurse clinic for ileal conduit care. The comprehensive preoperative counselling and education is crucial to help our patients and their significant others to go through the traumatic journey of radical cystectomy and ileal conduit. By providing the aforesaid counselling and dietetic education, patients could well-prepared themselves before the surgery and achieve the greatest support not only from the healthcare professionals but also the patients’ support group. Ultimately, it could enhance the post-operative recovery on our patients.