Radical cystectomy with the creation of a urinary diversion is a major surgical procedure. It takes several hours to perform the procedure and includes operating on the intestines. The recovery from this surgery can be expected to take much longer than shorter or less complicated procedures. Immediately after surgery on the intestines, their function is often not normal.
It usually takes several days for bowel function to return. During this time, many surgeons place a nasogastric tube to drain the fluid that would otherwise accumulate in the stomach and cause vomiting. The tube can usually be removed as soon as bowel function returns. The normal passing of gas best indicates the return of function. Once bowel function returns, a progressive diet will be tried. Clear liquids such as water, apple juice, Jell-O, or broth will be tried first. If these are well tolerated without nausea or vomiting, then about a day later solid food can begin again.
About a day or two after surgery, the nurses will help you to get out of bed, first to a chair but soon after to walk in the hallways. Pain control will be provided with intravenous medication until you are able to eat; then the intravenous medications will be stopped and oral pain pills will begin.
You will be ready to go home when your pain is well controlled with only pills, you are able to walk on your own power at least from bed to the bathroom, and you can tolerate regular food. This usually takes 5 to 10 days if all goes well.
Some people, particularly those who are older or who have multiple other medical problems, may need to go to a rehabilitation facility after the hospital instead of returning directly home. This is to allow for physical therapy or nursing care that could not be provided at home. Once the patient’s strength and healing has progressed sufficiently, he or she can then return home. When at home, expect good days and bad days rather than a steady gain each day. You will initially tire very easily, and you may nap during the day more than usual.
Your body is using a huge amount of your energy to repair itself after surgery, leaving little for your daily routine. For several weeks after surgery, you should not lift anything more than 5 to 10 pounds or do anything too stressful until the muscles and connective tissues have fully healed. It usually takes at least a month for your full energy to return.
Once you are completely healed, you will be able to resume virtually all of your prior activities. This usually takes about a month. Active patients who jogged, played tennis, golfed, skied, or participated in almost any other activity before surgery should be able to resume these activities in time.
If you have a urostomy bag that you worry could become dislodged, then placing a loose binder around the abdomen can provide some relief of the concern. Before surgery, your doctor and/or an ostomy nurse will help choose a site on your abdomen for the stoma that will allow for easy access and optimal concealment. Those patients with a neobladder will initially find that they need to urinate frequently to prevent leakage.
Over time, the neobladder stretches to accommodate larger amounts of urine, allowing longer times between voids.