RADICAL CYSTECTOMY AND NEOBLADDER
Discharge Instructions
Continue walking
The walking will help you build strength. Gradually increase the amount of walking you do each day. Take planned rest periods during the day. The best gauge is your own body and how you feel. It is very important that you continue walking when you are discharged from the hospital. Not only will this build strength but will also aid in preventing blood clot formation in the legs.
Abdominal binder
As you have an abdominal incision, it is advisable to wear the abdominal binder provided to you whenever you are sitting up and/or ambulating. The binder can be safely removed when lying down for prolonged periods like sleeping.
Avoid bending for 3 months
If you must pick something up, bend with your knees and not your waist.
Avoid heavy (Greater than 5 pounds) lifting for 3 months
Anything you need to brace yourself to pick up is too heavy. Also avoid strenuous activity.
Stairs should not be avoided
Take them slowly at first. You may wish to group your activities, so that you do not have to make many trips up and down stairs during the first week you are home.
Driving should be avoided
Driving should be avoided for at least 4 weeks after surgery or until you are pain free without medication. Take breaks every couple of hours if you are on extended trips. Get out of your car and walk around a bit. Avoid riding bicycles/motorbikes for 3 months
Driving should be avoided
Driving should be avoided for at least 4 weeks after surgery or until you are pain free without medication. Take breaks every couple hours if you are on extended trips. Get out of your car and walk around a bit. Avoid riding bicycles/motor bikes for 3 months
Bathing /Shower Instructions
Patients can scrub their bodies upon discharge from the hospital with lukewarm water and soap. Bathing/ showering should be avoided as you risk getting your incisions/dressings wet. Tub baths or hot tubs in the first 2 weeks are discouraged as this will allow for prolonged soaking of your incisions and increase the risk of infection. If your wound sites get wet, these must be patted dry immediately after scrubbing. You can resume bathing/showering with soap and water once the wounds have healed and sutures have been removed.
Managing your incisions
- Mild pain in incisions is normal/continue to take pain medications as advised
- Itching over wounds is a frequent occurrence and nothing to worry about.
Urine infection
Urine can have whitish mucus flakes. This mucus is produced by the bowel segment used to reconstruct your new bladder. This is nothing to worry about.
If in addition, urine becomes foul smelling, this may indicate a urinary infection. Please contact us immediately
Urine leakage
Your new bladder like that of a baby will initially leak involuntarily. It needs to be trained. Do not worry about initial urinary leakage
Continence will regain slowly
Practice Kegel exercises as advised.
Voiding instructions
- The neobladder created does not have normal sensation of filling. You may feel a sense of heaviness in the lower abdomen when your bladder is full.
- It is thus advisable that you pass urine every 2-3 hours during daytime.
- To pass urine, you need to relax pelvic muscles and may need to increase abdominal pressure (lower abdominal pressure can be applied)
- You may assume squatting position as well
- Restrict fluid intake after 7 pm in the evening
- Void once before going to bed at night
- Put an alarm, to get up at least once at night time to empty your bladder.
Groin/Genital Swelling
Right after surgery, you may have some swelling in your genitals and groin region. There may also be some discharge from your penis/vagina. This is normal, the swelling and discharge should go away over a few weeks.
Diet
While you are recovering, your appetite may be smaller than it was before surgery.
Eat several small meals throughout the day instead of 3 large meals. Eating like this will help your digestion and give you energy throughout the day.
Changes in bowel function
- When a part of your small intestine is removed to make the new bladder, the parts remaining have to adapt to change. During this time, you may experience few changes in your bowel habit. There may be diarrhea, constipation, cramps or bloating sensation. These changes may take few weeks to go away.
- If you become constipated please take the following measures: increase the roughage in your diet and drink 2-3 litres of water per day (to be avoided in heart patients).
Chest exercises
It is important to take care of for your lung health to avoid pneumonias.
For this please do the following:
- Incentive spirometry as taught
- Steam inhalation twice a day for 2 weeks
- Avoid breathing exercises that cause sudden increase in abdominal pressure like Kapalabhati
Medications:
- As per your discharge papers
- Continue medication for heart, thyroid or diabetes as before
- Blood thinners like Aspirin/Ecosprin/Clopidogrel to be restarted only after discussion with surgical team and cardiologist
- Regular follow up as advised
Red Alert Signs: Reasons to Call the Physician
- Your incision becomes red or swollen
- The skin around your incision is warmer than elsewhere and is slightly red
- There is drainage(pus/fluid) from your incision
- There is an opening in your incision if visible
- Your urine output become less than it normally has been
- There are chills or fever of 101degree Fahrenheit or more
- Severe pain that is not relieved by pain medications
- Blood in urine
- Foul smelling urine
- Inability to pass urine: RETENTION OF URINE