Cystectomy with continent reservoir

A cystectomy is surgery to remove part or all of your bladder. Sometimes other organs, lymph nodes, and part of the urethra are also removed. The urethra is a tube that carries urine from your bladder to outside your body.

To do the surgery, your doctor makes a cut in your lower belly. This cut is called an incision. If the doctor takes out all of your bladder, he or she will need to make a new way for you to pass urine. This is called a continent reservoir. It's a storage pouch that attaches inside your pelvis. It's made from a piece of your bowel. There are two types.

• A bladder substitution reservoir is used if your urethra is not removed. It's also called a neobladder. One end connects to your ureters. These are the tubes that carry urine from the kidneys to the bladder. The other connects to your urethra. With this type, you can urinate much as you did before surgery.
• A continent diversion reservoir with stoma is used if all or part of your urethra is removed. It's also called a urostomy. One end connects to your ureters. The other connects to an opening the doctor makes in your belly. This opening is called a stoma. When you want to urinate, you put a thin plastic tube through the stoma. The tube is called a catheter.

In the hospital, a nurse with special training will teach you how to care for your reservoir. Most people go home in 1 to 2 weeks. But 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. These include chemotherapy and radiation therapy.

Surgery to remove your bladder may affect your sexual or reproductive life. If a woman also has her uterus and ovaries removed, she will not be able to get pregnant. She could also start menopause and have hot flashes or other symptoms of menopause. And if a man has his prostate gland and seminal vesicles removed, he may have problems getting an erection. He will also not be able to get a woman pregnant. If you are a man who may want to father a child in the future, talk to your doctor. There are ways to save your sperm before the surgery.

It's common to feel sad or worried about how this surgery will affect you. It may help to join a support group. You can ask your doctor about these groups. You can also call the American Cancer Society (1-800-227-2345) for more information. Or you can visit its website at www.cancer.org.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

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 5 pounds 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 stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• 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 WOCN 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 WOCN'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 WOCN will help you with this.