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After your operation for invasive bladder cancer

Men and women discussing bladder cancer

This page has information about recovering from surgery for invasive bladder cancer. You can find information about

 

A quick guide to what's on this page

After your operation for invasive bladder cancer

After your operation you are likely to be in an intensive care unit for a couple of days. You can then have individual nursing care. 

You may have a drip for fluids. You may also have tubes to drain your wound. You may not be able to eat for a few days. But your nurse will give you water to drink and also high protein, high calorie drinks. You can usually start eating a few days after the surgery. 

It is important to tell your doctor or nurse about any pain straight away, so they can find the right type and dose of painkiller for you.

After urostomy

You will have a small hole like a spout on your abdomen (called a stoma) where your urine will drain out. The stoma has no nerve supply, so it doesn’t hurt. It will get smaller as it heals. At first, your stoma nurse may change your bags. They will help you when you change them yourself. After you go home, a stoma nurse or district nurse can visit to make sure that you are coping.

After continent urinary diversion, bladder reconstruction or recto sigmoid pouch

As with a urostomy, you will have a stoma after a continent urinary diversion. At first you will have a catheter in it, connected to a drainage bag. If you have bladder reconstruction or a recto sigmoid pouch, you will have a catheter into the new bladder for up to 3 weeks until the new bladder has healed.

Side effects of bladder surgery

Men will probably have their prostate gland removed during the operation. This will mean that you can no longer father a child. Also, the nerves that control erection can be damaged. For women, your vagina may be shortened during surgery. You may also have your womb removed. If so, you will no longer be able to have children.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating bladder cancer section.

 

 

After your operation

You are likely to be in an intensive care unit or high dependency unit for a day or two after your operation. This is so that your doctor and nurses can keep a close eye on you. When you first wake up, you may have a heart monitor connected to you.

Once you have recovered a little from the anaesthetic, the nurses and physiotherapists will help you to move around as soon as possible. Even when you are still in bed, they will help you to do deep breathing and leg exercises to help stop you getting a chest infection or blood clots in your legs.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

 


 

 

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

 

Drips and drains

To start with you may have a drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking.

When you wake up, you may have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You may have

  • One or more thin tubes called wound drains in the operation area to drain away any blood and tissue fluid that collects
  • A tube down your nose into your stomach (nasogastric tube) to drain fluid and stop you feeling sick
  • A bag or tube draining urine from your new stoma, if you have one
  • A tube going into your back (epidural) or into the muscle near the wound to give painkillers

If you have a bladder reconstruction, a continent urinary diversion or a recto sigmoid pouch you will have a tube (catheter) into the new bladder to drain urine and flush the new bladder regularly to get rid of blood clots.

If you have a stoma, your nurses will check how much it is draining every hour. If it is not draining, they may flush it out with sterile water in case it is blocked.

 

Eating and drinking

You may not be able to eat for a few days until your bowel has started working normally again. Your nurse will start offering you sips of water within a few hours. If you can cope with these, you will gradually be able to drink more and can then try eating a light diet. Gradually you will get back to normal over a few days. Your nurse will give you high protein, high calorie drinks to help maintain your nutrition. Once you are drinking plenty of fluids, your nurse will take your drip out.

 

Painkillers

You will have some pain for the first few days. But your doctors and nurses will do everything they can to make sure you are as comfortable as possible. There are many different pain killing drugs you can have and different ways of giving these drugs. For example you might have 

  • Painkillers into your spinal fluid through a tube in your back (an epidural)
  • A tube giving painkillers into the muscle near the wound (rectus sheath catheter)
  • A drip with painkillers in that you control yourself called patient controlled analgesia (PCA).

It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you have them regularly so it is important to take them as your doctor prescribes. If your pain is well controlled this will help you to be able to move around more easily and do your breathing and leg exercises.

 

Your urostomy

If you have a urostomy, you will have a stoma where your urine drains out of your body. The stoma looks like a small spout sticking out of your abdomen. It is red like the inside of your mouth. It has no nerve supply, so does not hurt. You must be careful not to injure it because you won't be able to feel it if you have done any damage.

The stoma will be swollen just after your operation. It will get smaller as it heals. At first it will produce thick white mucus, which collects in your bag along with the urine. Mucus production is normal for bowel tissue. The amount of mucus will gradually become less.

At first, your stoma nurse may change your urostomy bags. When you change them yourself they will help you if you need it. There are many different types of urostomy bags and the nurse will help you find out which is best for you. The bags are very flat and do not smell or rustle as you move around. Under ordinary clothes no one can tell you are wearing one. The bag can stay in place for a few days at a time. It has a tap at the bottom so you can empty it into the toilet.

Your stoma nurse will give you some urostomy bags to take home. They may set up an ordering system for you to get the bags from your local pharmacy prescription and delivery service. Or they may give you a prescription card with details of all the equipment you need. Then to get more bags you take the card to your GP. Your doctor will then give you a form called an FP10 to take to the chemist. You will also need to take a P11 form, which means that you don't have to pay prescription charges for your stoma equipment.

Your stoma nurse may visit you when you go home to make sure that you are coping. Or you may have a district nurse visit instead. Do feel free to ask for their help with any questions or difficulties you have. You could think about joining the Urostomy Association. You can meet other people with urostomies and keep up to date with new ideas.  Members can visit you before and after your operation to support you and give advice on how to cope.

 

Continent urinary diversion

Your stoma will eventually be less obvious than if you had a urostomy. At first it will be swollen and red. But, like the urostomy, it will shrink as it heals and will be far less noticeable. Also like the urostomy stoma, it is delicate and has no nerve supply. So you need to treat it gently.

At first, you will have a tube (catheter) into the stoma that is connected to a drainage bag. This is so your nurse can measure exactly how much urine you produce. You will have this tube in the stoma for 2 to 3 weeks. This allows the pouch to heal. It is important that the pouch does not become stretched by collecting urine until it is healed. But soon, you will only need to put a tube in to empty the pouch. This is called self catheterisation.

You will need to empty your pouch frequently in the first 2 to 3 months. Then you need to empty it at least every four hours. You will also need to wash out your pouch from time to time. This is called irrigation. It has to be done because the part of bowel that is used to make the pouch will carry on making mucus. The mucus has to be flushed out or it could block the stoma. 

Look at the living with bladder cancer section for information about life after bladder surgery, including self catheterising and irrigating.

 

Bladder reconstruction

When you wake up after bladder reconstruction, you will have a catheter into your new bladder. Your nurse will measure how much urine you are producing. The catheter will stay in for up to 3 weeks to allow your new bladder to heal. Your nurse will show you how to keep a record of how much urine you pass. If you are not passing enough urine or have difficulty passing any at all, the catheter may be put back for a short time. After this the catheter will be taken out. You will then begin to learn how to empty the new bladder by increasing the pressure in your (tummy) abdomen.

You will need to empty your pouch frequently in the first 2 to 3 months. Then you need to empty it every four hours. Most people soon feel comfortable with the technique. You will need to wake up once or twice at night to pass urine.

 

Recto sigmoid pouch

When you wake up after recto sigmoid pouch surgery, you will have a catheter into your new bladder. Your nurse will measure how much urine you are producing. The catheter will stay in for up to 3 weeks to allow your new bladder to heal. After this the catheter will be taken out and you will begin to learn how to empty the new bladder by increasing the pressure in your (tummy) abdomen

You will pass urine and stools through your back passage and will need to do this frequently in the first 2 to 3 months. Then you need to empty it every 2 to 3 hours. You will need to wake up once or twice at night to pass urine.

You are more likely to get kidney infections after this operation, because bacteria can travel up the ureters to the kidney from the bowel. So you need to drink plenty of liquids to try to prevent infection.

There is also an increase in the risk of bowel cancer after 15 to 20 years.

Look at the living with bladder cancer section for more information about life after bladder surgery.

 

Side effects of bladder surgery

Some people have some leakage of urine after a bladder reconstruction, particularly at night. Your own surgeon and specialist nurse will talk to you about how common this is, whether it is likely in your case, and what to do about it.

There are two main side effects of bladder surgery for men. The first is that you may not be able to get an erection afterwards. The nerves that control erection can be damaged during the operation. In some cases it may be possible for your surgeon to preserve these nerves so you will still be able to get erections.

You will probably have had your prostate gland removed during the operation to remove your bladder. This will mean that you can no longer father a child. Even if you can get an erection, you will not be able to ejaculate as you did before. 

There is information about sex life for men after bladder surgery in our living with bladder cancer section.

For women, your vagina may have to be shortened when your bladder is removed. Your surgeon will try to leave as much of your vagina as possible. You may also have had your womb removed during the surgery. This will mean you are no longer able to have children. 

We have information about sex life for women after bladder surgery.

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Updated: 23 October 2013