Radical Cystectomy and Postoperative Care for Bladder Cancer
Radical cystectomy (cystoprostatectomy in males and anterior exenteration in females) is a surgical procedure once considered the standard treatment for muscle-invasive bladder cancer. Radical cystectomy surgery is one of the most complex surgeries and has many post-operative care requirements to ensure a successful recovery.
What is Radical Cystectomy?
Radical cystectomy is a complex surgical procedure typically performed when bladder cancer has invaded the muscle layer of the bladder wall, or when there is a risk of it spreading further. The procedure involves the removal of:
- In Males: The entire bladder, prostate, seminal vesicles, both distal ureters and part of the urethra.
- In Females: The bladder, uterus, ovaries, fallopian tubes, part of the vagina, pelvic lymph nodes, and surrounding tissues.
In addition to the removal of these organs, the surgeon may also perform a pelvic lymph node dissection to check for any signs of cancer spread.
Types of Urinary Diversion After Radical Cystectomy
There are two primary options for urinary diversion:
- Ileal Conduit: A stoma is created on the right side of your abdomen, connecting to the intestine to allow urine to drain into a bag.
- Neobladder: An artificial bladder is formed from a section of the intestine and connected to your urethra for normal urination.
Immediate Post-Surgery Care for Radical Cystectomy
Post-operative care following radical cystectomy involves managing several medical devices and supporting the recovery process. Here is what you can expect immediately after surgery:
- Drainage Tubes: A drain will be placed in your abdomen to remove any excess fluid from the surgical site. It is typically removed before discharge.
- Intravenous (IV) Line: An IV line is used to administer medications, fluids, and nutrients during recovery.
- Heart Monitor: To track your heart rate and rhythm while you recover.
- Stents: Two small plastic tubes (stents) may be placed in your stoma. These will be removed during follow-up appointments with your urologist.
- Ostomy Bag: An ostomy bag will be placed over your stoma to collect urine from your ileal conduit.
- Oxygen Tube: A tube may be placed in your nose to provide supplemental oxygen during recovery.
- Massaging Stockings: These are worn to reduce the risk of blood clots during your post-surgery period.
Most of these would be sequentially removed before you leave the hospital, which would be anywhere between 6-10 days post-operatively.
Post Radical cystectomy Surgery Care at Home
Once you’re discharged from the hospital, you will need to continue your recovery at home with specific care instructions. Here’s what you should know:
Blood Clots
Patients will be limited in their activity upon returning home. This puts them at risk of developing dangerous blood clots. To minimize this risk, patients are often given prophylactic anti-coagulation (oral or injectable) postoperatively.
Stoma/Ostomy Care
Learning how to manage an ostomy is a new skill that can feel overwhelming. Patients typically get more accustomed to their stoma with time. However, some questions or challenges, such as leaking from their bag, may persist.
Changing Your Appliance:
After coming home from the hospital, patients typically need to change their ostomy bag by day 3, but this is dependent on the patient and may be earlier or later (up to 5 days).
Blood in Urine
Many patients wonder if it is normal to see blood in their urine. The answer to this question is yes, this can be seen following an appliance change, gentle washing, or exercise. This type of “bleeding” is very similar to bleeding from your gums after flossing or brushing your teeth. Of course, not all types of bleeding are normal, particularly if the blood in your urine is thick or has large clots.
Showering and Bathing
Showering after Radical cystectomy surgery is safe, but patients must be careful as they may be weak after the surgery. Having a relative nearby may be helpful to prevent falls.
You may shower and it is okay if your incisions have water run over them, once the sutures have been removed.
Activity and Exercise
While it may be tough, patients are strongly encouraged to begin walking early as this is one of the most important things to improve recovery and prevent complications after surgery. Staying active lowers your chance of life-threatening blood clots, lung collapse, infection, and wound problems.
Aim to spend at least 8 hours out of bed, even if that is sitting upright in a chair. Set daily walking goals and milestones.
Nutrition
Patients need to maintain a nutritious diet and stay hydrated following surgery. However, decreased appetite and weight loss are very common. Here are some tips to help prevent this:
- Eat 5-6 smaller meals, including a snack around bedtime
- Drink liquids that contain calories such as milk, soup, and protein drinks in between meals. These should be avoided during mealtime
Constipation
Constipation is not uncommon and can be very frustrating. You will often be prescribed stool softeners and laxatives to take following your discharge from the hospital. Additionally, be sure to drink at least 6-8 cups of liquid per day.
If you continue to experience constipation, contact your urologist and they can help.
Sleep Management
- Getting restful sleep following Radical cystectomy surgery can be challenging for some patients. However, sleep is an important factor in recovery
- Here are some simple recommendations that may help establish better sleep habits:
- Maintain a consistent sleep schedule by waking up at the same time every day
- Set a time to go to bed that is early enough to allow you at least 7 hours of sleep
- Do not go to bed unless you are sleepy
- Establish a relaxing bedtime routine
- Use your bed only for sleep
- Make your bedroom quiet and relaxing
- Keep the room at a cool, but comfortable, temperature
- Limit exposure to bright light in the evenings
- Turn off electronic devices at least 30 minutes before bedtime
- Don’t eat a large meal before bedtime
- Exercise regularly and maintain a healthy diet
- Avoid consuming caffeine in the late afternoon or evening
- Avoid consuming alcohol before bedtime
- Reduce your fluid intake before bedtime
If you are waking up at night to empty your pouch and this is interfering with your ability to get a restful sleep, you may want to consider a night-time drainage bag, or leg bag, to collect the urine while you sleep.
Neo-bladder Urinary Diversion
A neo-bladder is not your normal urinary bladder, but an artificial bladder fashioned from your intestines and re-anastomosed with your urethra. So do not expect to have normal bladder sensations or urine emptying straight away.
Emptying of this neo-bladder has to be learnt by giving moderate suprapubic pressure and simultaneous relaxation of your pelvic floor muscles. Ensure to learn this technique before leaving the hospital.
There will be some mucous coming out with urine- each time, which is normal. In certain cases, your urologist may teach you -Clean Intermittent catheterisation (CIC), where you would learn to self–empty your bladder with a single-use catheter.
Conclusion
Radical cystectomy is a complex procedure, requiring a skilled surgeon and post-operative care. If you or any of your loved ones are going in for this Radical cystectomy surgery. Specializing in the treatment of bladder cancer, Dr. Gaurav Aggarwal is the best uro-oncologist and robotic surgeon in Kolkata. Offers advanced treatment options in radical cystectomy and post-operative care ensures that patients receive the best treatment to allow them to regain a high quality of life after surgery.
For Radical cystectomy treatment, contact Dr Gaurav Aggarwal, the best uro-oncologist in Kolkata, immediately, without delay.
