Urologist Dr. Paul Perito Discusses Continent Urinary Diversion after Radical Cystectomy
Dr. Paul Perito
The removal of the bladder due to cancer is immediately followed by a procedure known as a continent diversion, says Miami-based urologist Dr. Paul Perito. This procedure is to create a neobladder (new bladder) and possibly urine expulsion capabilities through a urostomy (a plastic urine collection bag outside the body). The procedure utilizes a portion of the patient’s own lower intestine to create a man-made replacement of the organ, says Dr. Paul Perito. Recognized as an expert in the field of urology, Dr. Paul Perito notes that while many patients will be able to urinate almost the same way they did before the surgery, one must prepare for the possibility that an ileal conduit might be necessary. However, according to Dr. Paul Perito, patients whose urinary tract is left intact enough to connect the neobladder to the urethra will be able to live largely uninterrupted lives postoperatively.
Dr. Paul Perito notes that both male and female patients may have a need for intermittent self-catheterization following surgery. Women have about a 50% chance that this will be a regular necessity, and all patients are encouraged to catheterize at least once a month, after relieving themselves, to measure the amount of urine remaining in the neobladder, says Dr. Paul Perito. According to Dr. Paul Perito, this is important to halt the development of a secondary condition known as bladder distention.
Bacterial growth in the urine is unavoidable, says urologist Dr. Paul Perito. If no symptoms are present, the bacteria are considered benign and do not warrant antibiotics. However, if a kidney infection occurs a course of antibiotics will begin in and should be taken in its entirety. Another condition, says Dr. Paul Perito, is known as urinary retention and it poses a major threat to the patient and requires immediate medical attention and professional catheterization. Hypercontinence will occur in around 30% of female patients, with intermittent catheterization being the best management solution, adds Dr. Paul Perito.
Most patients experience around a 90% success rate of neobladder control, according to Dr. Paul Perito, however nighttime incontinence is not uncommon in the first 6 to 9 months and may continue indefinitely. Men may be better able to cope with nocturnal incontinence utilizing an external collection device known as a condom catheter. Patients will likely be on a restricted diet following a cystectomy and noebladder placement. Dr. Paul Perito also notes that urinary tract infections may be more severe in patients with a neobladder and are advised to contact their physician if they experience any symptoms of a UTI.
A cystectomy and neobladder replacement procedure usually takes around five hours and requires a 5 to 7 day hospital stay, reports Dr. Paul Perito. Full recovery may take 6 to 8 weeks and the patient will remain under the care of an urologist indefinitely for follow-up appointments. While Dr. Paul Perito says that this is definitely a life changing surgery, it does tend to offer a better quality of life for otherwise healthy patients who have overcome bladder cancer.
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Dr. Paul Perito is a Coral Gables, Florida-based urologist whose practice, Perito Urology, specializes in men’s health issues. Most notably, Dr. Perito has developed and actualized a minimally invasive penile implant procedure that is safe, efficacious, and proven to diminish the risk of infection to the patient. He is the Chairman of the Urology Department at Coral Gables Hospital as well as an active member of the American Urological Society. Dr. Paul Perito has traveled abroad extensively to promote his minimally invasive penile implant technique. He is a 1988 graduate of the University Of Maryland Medical School and also holds a BA in chemistry from Emory University.
The information contained in this article is provided by Dr. Paul Perito for educational purposes only. It is not intended to treat or diagnose any condition.