Cystectomy With Continent Cutaneous Urinary Diversion

WHAT YOU SHOULD KNOW:

• Cystectomy with continent cutaneous urinary diversion is surgery to remove your bladder. A new bladder or reservoir is made from a piece of your intestine. The ureters (tubes that go from the kidney to the bladder) are sewed into this new bladder. The end of the new bladder will come out of a hole in the skin on your abdomen. This is called a stoma.
  
  
• You may need this surgery if you have cancer of the bladder. This surgery may be able to cure the cancer. You may need this surgery after an accident or illness, such as one that caused you to become paralyzed. You will need to put a catheter (thin bendable tube) into the stoma around 5 times a day to drain the urine.

AFTER YOU LEAVE:

• Medicines:
  
  
  • Keep a written list of what medicines you take and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicines. Do not take any medicines without first talking to caregivers.
    
    
  • Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking it until you discuss it with your caregiver. If you are taking antibiotics, take them until they are all gone even if you feel better.
    
    
  • If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  
  
• Ask for information about where and when to go for follow-up visits: For continuing care, treatments, or home services, ask for more information.
  
  
  • Caregivers may have you go to the lab for a urine test 3 days before your 1st appointment. This way you can be given antibiotics if there is a chance of infection.
    
    
  • Tests may be done during this appointment, such as an IVP or CT Scan. These tests tell caregivers if the urine is flowing the right direction in and out of the new bladder. The tests can also show if anything is blocking the flow of urine from the kidney to your new bladder.
  
  
• When you are allowed to bathe or shower, carefully wash the stitches/staples and stoma gently with soap and water. Afterwards put a clean, new bandage over the incision. Or, change your bandage any time it gets wet or dirty. If you cannot reach the bandage, ask someone else to help you change it.
  
  
• Caregivers will teach you how to care for your stoma. You may be told to drain your new bladder every 2 hours for the first week. Then catheterize the new bladder every 3 hours for the next 6 weeks. After that, catheterize the new bladder every 4 hours during the day. You may be allowed to skip 1 catheterization during the night if you are not having any problems.
  
  
• Caregivers will also teach you how to irrigate your new bladder 1 to 2 times a day. This means that you will put salt water through a catheter that you put in your stoma to clean out mucous.
  
  
• Eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Let your caregiver know if you cannot make yourself eat.
  
  
• It may be hard for you to have a BM after surgery. Don't try to push the BM out if it's too hard. Walking is the best way to get your bowels moving. Eat foods high in fiber to make it easier to have a BM. Good examples are high fiber cereals, beans, vegetables, and whole grain breads. Prune juice may help make the BM softer. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular. You can buy these medicines at a grocery or drug store.
  
  
• Drink 6 to 8 (eight ounce) glasses of liquid each day. Drinking liquids can help prevent constipation. Or, follow your caregiver's advice if you must limit the amount of liquid you drink. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink, such as coffee, tea, and soda.
  
  
• You may feel like resting more after surgery. Slowly start to do more each day. Rest when you feel it is needed.
  
  
• Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy.
  
  
• Avoid lifting heavy objects.
  
  
• Stay away from large crowds the first week or two after surgery. This helps you keep from getting an infection.
  
  
• Ask caregivers when you can begin driving a car again.
  
  
• Ask your caregiver when you can return to work or school.
  
  
• You may have sex when you feel ready. Stop if it causes pain. Some patients may have problems with sex after having this surgery. These problems usually do not last forever and most can be helped. Talk to your caregiver if you are worried. He/she can help you find ways to handle these problems.
  
  
• If you smoke, you should quit. It harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. If you are having trouble quitting, ask your caregiver about the CareNotes™ handout on how to stop smoking.
  
  
• You may feel scared, confused, and anxious because you have bladder cancer. You may blame yourself and think you have done something wrong. These feelings are common. Talk about them with your caregiver or with someone close to you. Ask your caregiver about support groups for people with cancer. Such a group can give you support and information.

CONTACT A CAREGIVER IF:

• Your stitches or staples come apart.
  
  
• Your bandage becomes soaked with blood.
  
  
• You do not get urine when you catheterize the stoma.
  
  
• The skin around your stitches is red, swollen, or begins to leak fluid. This may mean that you have an infection.
  
  
• You have chills, a cough, or feel weak and achy. These are signs that you may have an infection.
  
  
• You have trouble breathing or your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic to your medicine.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You have questions or concerns about your injury, illness, or medicine.

SEEK CARE IMMEDIATELY IF:

• You have a fever.
  
  
• You suddenly feel lightheaded and have trouble breathing.

• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.