his guide will help you prepare for your bladder surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.
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About Your Surgery
Your urinary system is made up of organs that make urine and get it out of your body (see Figure 1).
Your kidneys clean the toxins out of your blood and make urine.
Your ureters are tubes that carry urine from your kidneys to your bladder.
Your bladder stores urine until you feel the need to urinate.
Your urethra is a tube that carries the urine in your bladder out of your body when you urinate.
In women, the urethra is very short. It’s located above the vagina.
In men, the tube is longer. It passes through the prostate gland and penis.
Figure 1. Your urinary system
Figure 1. Your urinary system
Removing your bladder
Surgery to remove your entire bladder is called a radical cystectomy.
During your surgery, your doctor will remove your bladder and some of the lymph nodes near your bladder. Then, they will rebuild your urinary system.
About lymph nodes
Lymph nodes are small, bean-shaped glands that are located throughout your body. They’re part of your lymphatic system, which is part of your body’s immune system. Lymph nodes are removed during your surgery because they may also contain cancer cells.
If you’ve had surgery or radiation therapy to your pelvis in the past, your doctor may remove fewer lymph nodes. This is done to avoid problems after your surgery.
Removing other organs near your bladder
In addition to your bladder and lymph nodes, your doctor may need to remove other organs near your bladder. This is done to make sure all of the cancer is removed.
In men, the following organs may be removed:
Part of the vasa deferentia
In women, the following organs may be removed:
Part of the vagina
Creating your neobladder
After your bladder is removed, your doctor will create a new pouch to hold your urine. This is called a urinary diversion. The type you will have is called a neobladder.
Before your surgery, you and your doctor will talk about which type of urinary diversion may be best for you. However, your doctor will make the final decision during your surgery. Your doctor will talk with you about how they make this decision and why a backup plan is needed.
Your doctor will use a small piece of your small intestine to create your neobladder. One end of your neobladder will be attached to your ureters. The other end will be attached to your urethra. After your surgery, your urine will flow from your kidneys, through your ureters, and into your neobladder.
You will use the muscles in your abdomen to empty your neobladder. This is different from how you empty your natural bladder. Sometimes, you may need to put a catheter through your urethra into your neobladder to completely empty it. You will learn how to do these things after your surgery.
This surgery usually takes about 4 to 7 hours. It may take longer if you have other medical conditions or have had past surgeries.
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Before Your Surgery
The information in this section will help you get ready for your surgery. Read this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.
As you read through this section, write down any questions you want to ask your healthcare provider.
Preparing for your surgery
You and your healthcare team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
I take prescription medications (medications prescribed by a doctor), including patches and creams.
I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
I take dietary supplements, such as herbs, vitamins, minerals, and natural or home remedies.
I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
I have sleep apnea.
I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
I am allergic to certain medication(s) or materials, including latex.
I am not willing to receive a blood transfusion.
I drink alcohol.
I use recreational drugs.
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medication to help prevent them.
If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do to prevent problems before your surgery:
Be honest with your healthcare provider about how much alcohol you drink.
Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
Tell your healthcare provider if you can’t stop drinking.
Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About sleep apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
About Enhanced Recovery After Surgery (ERAS)
ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.
Before your surgery, make sure you’re ready by doing the following things:
Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your doctor or nurse at your next appointment, or you can call your doctor’s office.
Exercise and eat a healthy diet. This will help get your body ready for your surgery.
After your surgery, help yourself recover more quickly by doing the following things:
Read your recovery pathway. Your nurse will give you a pathway with goals for your recovery. It will help you know what to do and expect on each day during your recovery.
Start eating and moving around as soon as you can. The sooner you’re able to eat, get out of bed, and walk, the quicker you will be able to get back to your normal activities.
Within 30 days of your surgery
Presurgical Testing (PST)
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your doctor’s office.
You can eat and take your usual medications the day of your PST appointment.
During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
It’s very helpful to bring the following things to your PST appointment:
A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
The name(s) and telephone number(s) of your doctor(s).
Identify your caregiver
Your caregiver plays an important role in your care.
You and your caregiver will learn about your surgery from your doctor and nurse.
Your caregiver will need to take you home after your surgery.
Complete a health care proxy form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you’re unable to communicate for yourself. The person you identify is called your health care agent.
If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it to your next appointment.
Meet with a Wound, Ostomy, and Continence (WOC) Nurse, if needed
A WOC nurse is a nurse who specializes in caring for wounds, stomas, and other skin issues. They can also help you if you’re having problems with incontinence (not being able to control when you urinate).
Before your surgery, your WOC nurse can talk with you about what to expect when you have a neobladder. They may also mark a site on your abdomen where a stoma may be placed. The site will be the best possible location, away from scars, creases, folds, and if possible, in an area that will make it easy for you to care for it.
Even if your doctor doesn’t think you will need a stoma, they may have your WOC nurse mark a site anyway. This is done in case the surgical plan changes based on findings during your surgery.
Do breathing and coughing exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Consider our sexual health programs
Bladder surgery will affect your sexual health. If you have any concerns about how it will affect you, think about making an appointment with one of our sexual health clinics.
Information for men
Bladder surgery can cause changes in erectile function (your ability to get and keep an erection). Most men have erectile dysfunction (ED) after surgery. ED is when you have trouble getting or keeping an erection.
Your doctor will talk with you about what to expect about having erections again after surgery. There are many types of treatments for ED, including pills, injections (shots), or a prosthesis (implant). Your doctor can discuss these options with you.
Because your prostate will be removed during your surgery, you won’t be able to father children after your surgery. If you want to have children in the future, you may want to bank your sperm before surgery. Ask your nurse for information about sperm banking if you want to bank your sperm.
To see a specialist in the Male Sexual & Reproductive Medicine Program, call 646-888-6024.
Information for women
If your reproductive organs are removed, you won’t be able to bear children after your surgery. If you want to have children in the future, you may want to think about family planning options (such as egg freezing) before your surgery. Your doctor can discuss these options with you.
You may also have changes in sexual function after your surgery. These may include a shorter vagina and menopause. Menopause is when you no longer have a menstrual period. Your doctor will talk with you about what to expect. They can also discuss your treatment options with you in more detail.
To see a specialist in the Female Sexual Medicine & Women’s Health Program, call 646-888-5076.
Try to do aerobic exercise every day. Examples of aerobic exercise include walking at least 1 mile (1.6 kilometers), swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping market. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier. For more information about exercising, read the resource General Exercise Program: Level 2.
Eat a healthy diet
Eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your doctor or nurse about meeting with a dietitian.
Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)
4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.
You will need to follow a liquid diet before your surgery. Now is a good time to buy your supplies. For a list of liquids you can drink, read the section “Follow a Liquid Diet.”
Do pelvic floor muscle (Kegel) exercises
Kegel exercises will strengthen your pelvic floor muscles, which will be weakened from your surgery. Your pelvic floor muscles are the muscles you use to stop the stream of urine while you’re urinating. You will use your pelvic floor muscles when you empty your neobladder.
Practice doing Kegel exercises before your surgery so you’ll know how it should feel. Your nurse will give you information about how to do Kegel exercises.