Got to love a surgeon who says he’s ready but wants to make sure I really want to do this. Are you ok the way you are? He asked. The answer is no. Lets do it!
No way Dr. Breyer would recommend a “continent diversion” using more of my small intestine to build an internal “replacement bladder” with a port to cath through. Just too much tissue damage already in the area from previous surgeries and radiation. Plus the ports fail frequently and required more surgery to replace. Nope…It’s a full urostomy or stay with the foley cath. As it is, I cannot go bike riding, no surfing, likely UTIs that have in the past almost killed me. DECISION: Let’s do it!
Possible complications due to previous surgery for colon cancer in 1986 and possible tissue damage from radiation treatments following. Dr. Breyer said it might be like undoing a bowel of day old pasta, all stuck together. He will remove a 4-6 inch section on the ilium (junction between small intestine and large intestine), stitch the intestine back together and move the excised section and it’s blood supply to where it will be brought out through my abdomen to form a stoma (exit for the urine.) The ureters (which connect the kidneys to the bladder) will be disconnected from the bladder and stitched into the “ilium conduit”, so that the urine will flow from the kidneys down the ureters, into the ilium conduit and out through the stoma into an ostomy pouch.
Possible complications include unsticking the jumble of day old pasta (intestines) to excise the ilium conduit and associated blood supply, stricture in the ureters, collapse of the stoma or ilium conduit and infection. Bladder will remain intact (but non functional), so there may be some drainage of mucus through the previously rerouted urethrea. So I may need to wear a small pad in my underwear. Sigh.
Diane, one of the wonderful WOCNs at UCSF Med Center did a stoma marking on me to ensure that the ostomy appliance would fit well and not leak. I thought I had a pretty flat stomach, but XMAS candy has put on a few pounds and so finding just the right place to guide Dr. Breyer for stoma placement was challenging. But, Diane did her magic and using a sharpee, marked the best spot. Dr. Breyer said it look like a good spot, and would try for placement there, but my internal arrangements would be the final decision maker in where the stoma goes. Well, at least, he’s go a target to shoot for.