Cystectomy With Continent Reservoir: What to Expect at Home

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Your Recovery

A cystectomy is surgery to remove part or all of the bladder. The surgery is mainly used to treat bladder cancer.

After surgery, your belly will be sore, and you will probably need pain medicine for 1 to 2 weeks. You may notice some blood in your urine or that your urine is light pink for the first 3 weeks after surgery. This is normal.

If you have a urostomy (stoma), you can expect it to be swollen and tender at first. This usually improves after 2 to 3 weeks. A stoma is an opening the doctor makes in your belly. It connects to the newly created bladder so you can drain urine. You do this by placing a small plastic tube into your stoma. You decide when to do this.

If you have a neobladder, you will have a thin plastic tube (catheter) coming out of your urethra for about 3 weeks. When it is removed, you will urinate much as you always have, but you will need to set a time to urinate for the first few months after surgery. Your doctor will tell you how to do this. You will probably leak urine for a few months. Within 1 year, you should be able to control when you urinate.

While you recover from surgery, you will also learn to care for your stoma (if you have one) and your catheter. You may find it helpful to meet several times with a nurse who can teach you how to do this.

You will probably need 6 to 8 weeks to get back to your usual routine. If your surgery was done to treat bladder cancer, you may need other treatments after surgery, such as chemotherapy or radiation therapy.

Bladder cancer surgery may affect sexual function. If a woman's uterus and ovaries are removed during the surgery, she will not be able to get pregnant, and menopause may start. She may have hot flashes and other symptoms of menopause. And if a man's prostate gland and seminal vesicles are removed, he may have problems getting an erection and will not be able to make a woman pregnant.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. You may use stairs when you return home, but take them slowly. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
  • Avoid lifting more than 2.5 kilograms for about 4 weeks or until your doctor says it is okay. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
  • Avoid bending. If you have to pick something up, bend at your knees (not at your waist) and pick up the object.
  • Ask your doctor when you can drive again.
  • You will probably be able to go back to work or your normal routine in 6 to 8 weeks. This depends on the type of work you do and whether you have any further treatment.
  • You may take a shower. When you shower, keep your catheter taped to your leg. Empty the urine before you start.
  • Do not take a bath until the catheter has been removed.
  • If you have a stoma, gently pat the skin around it dry after bathing.
  • Ask your doctor when it is okay for you to have sex.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids to avoid becoming dehydrated.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
  • Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • Keep the area clean and dry.

Other instructions

  • You will leak urine during the night for a while, so you will need a pad to absorb the urine (incontinence pad).
  • To control pain when you cough or sneeze, hold a pillow over your incision.
  • You will need to wash out your new bladder so mucus does not collect and block it. Your doctor or nurse will teach you how to do this.
  • If you have a neobladder:
    • You will have a urinary catheter for about 3 weeks. Your doctor or nurse will tell you how to care for it.
    • Be sure the catheter is securely taped to your thigh and connected to the large drainage bag most of the time. Use the smaller leg bag only when you go out.
    • A little leakage around the catheter is normal.
    • Your new bladder does not have a nerve supply, so you will not have an urge that tells you when to urinate. You will need a set time to urinate for the first few months after surgery. Your doctor will tell you how to do this.
    • You will have to learn how to use your sphincter and belly muscles to urinate. Your doctor will tell you how to do this and give you exercises to make them strong.
    • You may sometimes need to use a catheter to make sure no urine is left in your new bladder. Leaving urine in the bladder can cause kidney problems or infection. Your doctor or nurse will help you with this.
  • If you have a continent diversion reservoir with stoma:
    • Follow your doctor's or nurse's instructions for caring for your stoma.
    • You do not need a bag to collect urine. The new bladder will store urine until you empty it. You do this by placing a small plastic tube into your stoma. You will learn to recognize how it feels when your new bladder is full. Your doctor or nurse will help you with this.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have severe belly pain, or nausea and vomiting.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have pain that does not get better after you take pain medicine.
  • You have a fever over 38°C.
  • You have loose stitches, or your incision comes open.
  • You are bleeding from the incision.
  • You have a stoma and:
    • You have signs of infection, such as red streaks or pus around your stoma.
    • Your stoma turns pale or dark purple.
    • Your stoma swells or bleeds.
  • You have little or no urine going into the pouch.
  • Your urine becomes cloudy or smells very bad.
  • You have pus or clots of blood in your urine.
  • You have trouble with the catheter, or it comes out.
  • You have pain in your back just below your rib cage. This is called flank pain.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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