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Open Radical Cystectomy

If the cancer is larger or is in more than one part of the bladder, a radical cystectomy is needed. This operation removes the entire bladder and nearby lymph nodes. In men, the prostate is also removed. In women, the ovaries, fallopian tubes (tubes that connect the ovaries and uterus), the uterus (womb) and a small portion of the vagina are often removed along with the bladder.

General anesthesia (where you are in a deep sleep) is used for either type of cystectomy.

These surgeries are typically done through a cut (incision) into the abdomen. You will need to stay in the hospital for about a week after the surgery. You can usually go back to your normal activities in 4 to 6 weeks.

In some cases, the surgeon may operate through several smaller incisions using special long, thin instruments, one of which has a tiny video camera on the end to see inside the pelvis. This is known as laparoscopic, or “keyhole” surgery. The surgeon may either hold the instruments directly or may sit at a control panel in the operating room and maneuver robotic arms to do the surgery. If it can be done, laparoscopic surgery may result in less pain and quicker recovery after the operation (due to the smaller incisions). But it has not been around as long as the standard type of surgery and it’s not yet clear if it is equally as effective.

It is important that any type of cystectomy be done by a surgeon with experience in treating bladder cancer. If the surgery is not done well, the cancer is more likely to come back.

When you get home:

Diet

You may return to your normal diet immediately. Fluids, especially water, are particularly helpful to keep the flow of urine up. You have no real restrictions, However be aware that heavier foods may irritate your abdomen. Proteins (meat, fish, chicken) are very important in the healing process to rebuild damaged tissue. Vitamins are OK, especially if you are not eating a well-balanced diet.

Activity

Your physical activity is to be restricted, especially during the first two weeks home. You may walk as much as you feel up to. During this time use the following guidelines:

  • No lifting heavy objects (anything greater than 10 lbs).
  • No driving a car and limit long car rides.
  • No strenuous exercise.

Medication

You should resume your pre-surgery medication unless told not to. You may be discharged with Iron tablets to build up your blood count. Pain pills (Tylox or Tylenol with Codeine) may also be given to help with wound and catheter discomfort. Tylenol (acetaminophen) or Advil (Ibuprofen) which have no narcotics are better if the pain is not too bad.

Stomal Care / Neo-Bladder / Continent Diversion

Patients with neo-bladders or continent diversion will go home with catheters in place. Separate instruction sheets will explain the care of the catheters and drainage bags. If a stoma or urostomy was created it will be covered by the stomal therapists and ourselves with other handouts and instructions before your discharge.

Hygiene

You may shower or bathe as soon as you get home.

Side Effects:

Bowels: You may have diarrhea because of the bowel surgery and its effect on bowel function.Or because of the use of narcotics for pain relief, you could also experience constipation. If the diarrhea is severe (more than two loose stools a day), we do have medication that can help. If it is not too severe, you can try Imodium AD, a drug that can be purchased over the counter at your pharmacy. If you are constipated then a mild laxative is fine. (Milk of Magnesia 2-3 Tablespoons, or 2 Dulcolax tablets as example). A bowel movement every other day is reasonable. Your bowel function will usually return to normal within six weeks.

Problems you should report to us:

  • Fevers over 101.3 Fahrenheit.
  • Drug reactions (Hives, rash, nausea).
  • Bowel problems (constipation, vomiting, diarrhea).

Follow Up: 

You will need a follow-up appointment to monitor your progress. Call for this appointment when you get home or from the phone in your hospital room before leaving. Usually the first appointment will be about 1-2 weeks after your surgery.