Precautions for patients after total cystectomy + orthotopic neobladder surgery

With the progress of society, medical technology has become more and more advanced, bringing convenience to our lives. Some difficult and complicated diseases have been solved through scientific means. Patients who have undergone cystectomy + in situ neobladder surgery have suffered serious negative psychological effects. Therefore, it is very necessary to understand some postoperative matters to help patients eliminate their psychological shadows.

1. Develop the habit of urinating on time

The new bladder made of intestines is less sensitive to urinary bloating. To avoid the new bladder being overfilled with urine, which may cause the bladder to be too large and absorb too much waste, you need to urinate regularly. The time to urinate is determined by the amount of water you drink and the amount of urine you urinate. Generally, urinating once every 2-3 hours is enough.

2. Drink adequate water

You need to have enough urine every day to completely discharge waste from your body. A large amount of urine also helps discharge mucus from the new bladder. However, you should avoid drinking too much water and producing a large amount of urine in a short period of time, as this may induce kidney hydrops. It is better to drink a moderate amount of water several times to maintain a relatively stable urine volume.

3. Train the new bladder to urinate

Adapting to changes in bladder capacity

The newly made new bladder usually has a smaller capacity, and there will be frequent urination, but as time goes by, the capacity of the new bladder will gradually increase. Generally, 3 to 6 months after the operation, it can gradually reach 300 to 400 ml. It is ideal to maintain this state.

Training the urethra to control urine

When the bladder is removed, the proximal urethra (i.e., posterior urethra) connected to the bladder is also removed, which affects the urethra's ability to control urine. In addition, the new bladder has a small capacity, so there will be frequent urination or even urinary incontinence in the early stage after surgery. Persistent anal lifting exercises can enhance the urethra's ability to control urine.

Training the neobladder to urinate

The new bladder relies on two main aspects to urinate. First, the urethra should be actively relaxed and opened when urinating. Second, the pressure in the new bladder should be increased by using abdominal pressure. The coordination of these two aspects can lead to smooth urination. Therefore, every time you urinate, you should use your mind to relax the urethra, and then use your palms to continuously press the abdomen below the navel to apply pressure. Generally, it is easier to relax the urethra when you urinate while sitting on the toilet. If the urine in the new bladder is not completely drained, walk around a few times after urinating, and then urinate again.

4. Regularly check bladder capacity and residual urine volume

If the bladder capacity is too large or the residual urine volume in the bladder is too much, it will not only affect the function of the new bladder, but also increase the absorption of waste in the urine. The new bladder capacity and the residual urine volume of the new bladder need to be measured regularly (usually measured by B-ultrasound). If it is too much, you must find a surgeon or urologist to deal with it.

5. Regularly test kidney function

Due to excessive residual urine volume and obstruction of the connection between the ureter and the new bladder, the ureter and kidney may accumulate water and have functional disorders. Therefore, lifelong monitoring is required, and any problems must be treated promptly once they are discovered.

6. Go back to the hospital for regular checkups

After the operation, you should return to the hospital for a follow-up examination every 3 months, including blood routine, liver and kidney function, urine routine, color Doppler ultrasound, chest X-ray, etc., and CT or MRI if necessary. During the follow-up examination, you should also tell the doctor about your urination during the day and night, your urination control, and your diet and sleep.

7. Dietary precautions

Avoid fried, deep-fried, spicy and irritating foods, and control the intake of protein foods appropriately, because excessive protein diet will increase the burden on the kidneys, which will affect kidney function in the long run. Eat more fresh fruits and vegetables to supplement enough vitamins and trace elements to maintain the body's daily needs.