The aim of the Enhanced Recovery Programme (ERP) is to get you back to full health as quickly as possible after your operation. Research indicates that after surgery, the earlier you get out of bed, mobilising and start eating and drinking the better. This will speed up your recovery making it less likely that complications will develop.
The benefits of getting you to mobilise early include:
- You will return to eating and drinking much sooner
- You will have a reduced risk of developing blood clots
- You will reduce the risk of a chest infection
- There will be less muscle wasting, so that function and mobility are maintained
- You will feel less tired
To achieve this, we need you to work in partnership with us so that we can help you to speed up your recovery. This information will increase your understanding of the programme and ensure you play an active role in the preparation for your operation and your recovery.
Before you come into hospital your surgeon and specialist nurse will see you and explain the programme to you and your family. At this appointment you will be given the opportunity to ask questions. It is advisable to bring someone along with you to this appointment either a friend or family member.
Below is a picture of your urological system. Your surgeon or specialist nurse will draw on it to show which part is to be removed.
This information is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.
At UCLH, we are fortunate to have a very experienced team that will help you through what is a very daunting and long journey from your diagnosis, treatment and recovery. The care we provide would not be possible without the efforts of our huge team.
Surgical Team
- The surgical team consists of the consultant surgeons who will perform your surgery, and the experienced senior urology registrars and nurses who assist in your surgery and post-operative care.
- Our anesthetists are specialised in robotic surgery and care for medically and anaesthetically complex patients, as is often the case in bladder cancer.
Specialist Nurses and Coordinators
- Our bladder cancer surgical coordinators will ensure that your journey to surgery is smooth, including arranging appointments and tests, and ensuring your follow- up after surgery is timely.
- Highly experienced specialists nurses in uro-oncology and bladder cancer will follow you from your initial interaction with the department, through to your follow-up after discharge from surgery.
- We have a team of urinary diversion nurses, who specialise in stoma and neobladder care, and provide an invaluable resource to help you through what is often a life-changing experience
Intensive Care Staff
- Immediately after your surgery, you will be looked after in a high-dependency intensive care ward. Our intensive care team includes specialist nurses and doctors, who routinely look after patients who have undergone cystectomy.
- Even after discharge from intensive care to the ward, they remain involved in your care where needed.
Ward Team
- The team looking after you on the ward includes doctors, nurses, physiotherapists and pharmacists with extensive experience in managing cystectomy patients.
- Care will be consultant led throughout your hospital stay.
Urinary diversion nurses are specialist nurses in stoma and neobladder care. Most patients who attend the pre-assessment clinic will have a good idea of whether or not they will be having a urostomy (stoma) or a neobladder. However, if you haven’t made up your mind, our urinary diversion nurses will see you at the pre-assessment clinic and help you decide and also provide you with necessary information.
These specialist nurses have a significant role in following you throughout your journey, from pre-assessment to post-surgery. Our urinary diversion nurses will see you prior to your admission and provide support and information. They will then see you again immediately before your operation to mark a suitable site on your abdomen for a urostomy and will provide ongoing support and education. If you are having a neobladder, a mark will still be required, in the event that a neobladder cannot be performed and a urostomy is then made (although this is exceptionally rare).
They will also see you everyday after your operation. On the day after your operation you will be encouraged to learn to care for your stoma. You will not be sent home until you can manage your stoma by yourself. If you are having a neobladder, you will be encouraged to care for it the day after surgery, and similarly you will not be sent home until you can care for it by yourself.
What Things Can I Do to Help Prepare for Surgery?
- Try to eat as healthily as possible. This includes eating plenty of fruit, vegetables, protein and some carbohydrates. It also includes healthy fats like olive oil and avocado.
- Do not excessively diet. Avoid excessively dieting in the weeks before an operation but also avoid putting on a lot of weight.
- Ensure adequate exercise. We recommend that you walk 30 minutes per day
- Quit smoking. If you are a smoker it is advisable for you to stop. You may wish to contact a local helpline, or if you have access to the internet log on to www.
nhs.uk/ for help and advice about quitting smoking.smokefree - Reduce or stop alcohol. If you drink alcohol, we advise that you reduce the amount or stop completely.
- See your GP to optimise your medications. If you are diabetic or you are taking tablets for your heart or lungs, you should make an early appointment with your G.P. so that they can ensure your medication is the best possible before surgery. Show them this booklet to let them know that the hospital has advised you to do this.
- Arrange to get some help for your recovery. Think about how you can cope in the weeks after surgery when you are convalescing. Can you arrange help from family or friends? If you think that you will have problems at home after your operation then seek help early so a suitable solution can be found before your operation.
- Make a note of any concerns you may have. Make sure that you raise any concerns that you have in the pre-assessment clinic or with your specialist nurse. It is advisable to bring a friend or member of your family to all your appointments (but check if this is allowed)
What Can I Eat and Drink before My Operation?
- Low residue diet. You will be asked to start a low residue diet two days before your operation. This means avoiding foods that your body will find hard to completely digest (nuts, grains, seeds, raw or dried fruits). You will be given a diet sheet at your pre-assessment appointment that will tell you how to do this.
- Supplemental drinks. A key aspect of the enhanced recovery programme is that you will be given nutrition supplement drinks before your surgery, unless you are a diabetic (as these drinks contain a high sugar content). The benefit of these drinks is that they will give you the much-needed energy which you will require to help you recover. We generally ask that you take two drinks at 6am on the morning of your surgery.
Before your surgery, you will be seen in a face-to-face clinic, where you will meet the bladder cancer surgery team, including the specialist nurses, urinary diversion nurses, surgeons and anaesthetists. You will also be asked to have some blood tests performed, an ECG (test of your hearbeat) , and provide a urine sample to ensure there is no infection. A nasal swab will also be taken to check for MRSA (see below).
Please Bring With You:
- Your medications. Any medicines that you usually take including vitamins, homeopathic and herbal remedies. The pre–assessment team will tell you which of your medications should be taken before and on the day of your surgery and also of any that you should stop taking.
- Contact numbers including your next of kin and family/friends. We will make a record of these, should we need to contact anyone. It is important for you to tell us as early as possible if you have any concerns about whether you will be able to manage your daily activities when you are discharged after your surgery. We will help you make the necessary arrangements.
The purpose of the clinic is to assess your fitness for a general anaesthetic and provide you with specific information about your admission. This ensures that your operation and stay goes as smoothly as possible. This will be an opportunity for you to ask questions and tell us about your individual needs and circumstances. If any potential changes to the home environment are required to help with recovery, you may be referred to the Occupational Therapist who will contact you prior to surgery.
During your appointment one painless swab will need to be taken, from inside the nose. You can do this yourself if you prefer. Guidance will be given at the time.
These are the areas of the body where MRSA is if MRSA is present – it can take up to three working days to get the results. If your swabs come back positive we will inform you straight away and let you know what treatment is needed.
MRSA stands for Methicillin Resistant Staphylococcus Aureus. This is a form of Staphylococcus Aureus (SA). SA is the commonest type of bacteria which can infect humans. About a third of the population are colonised with SA. Colonised means the organism lives harmlessly on skin or in the nose. SA causes problems when it enters the body, and this is most likely when patients are unwell. MRSA is a variety of SA that tends to spread easily. You will be given a leaflet about MRSA at your preoperative assessment.
If you have any concerns about the date of your operation, please contact the pathway coordinator: Telephone 020 3447 9485.
Patients are often admitted the day of surgery. More details will be in your admission letter. We expect that you will stay in hospital for between seven and fourteen days after your surgery.
What Do I Need to Bring?
- Your medications. Please bring into hospital any medication that you usually take (both prescription and non prescription).
- Toiletry bag. We suggest you bring in a toilet bag with wash things, towel, box of tissues, loose-fitting night clothes and day clothes, dressing gown, slippers, maybe a book or magazines
- Electronic devices. This includes your phone and charger, or even a laptop or iPad. There are no televisions in hospital to watch. However, there is free hospital WiFi that can be accessed. Please be vigilant at all times about your belongings.
- Mobility equipment. Bring any mobility aids or specialist equipment you usually use to help you get around e.g. walking stick, wheelchair, and specialist footwear. If possible, clearly label equipment with your name.
- Do not bring in anything of potential value e.g. jewellery, credit cards etc. Please keep your property to a minimum, as there is limited space in your locker. The ideal suitcase size is an airline bag suitable for hand luggage.
What Will I Be Given?
- Stockings. You will be given a pair of below-knee surgical stockings to wear on your arrival at the hospital. These will reduce the risk of blood clots forming in your leg veins. Please ensure that when you leave hospital, you have two pairs in total (one to wear and one to wash). You will need to wear these stockings everyday for 28 days.
- Injections to prevent clots. Similarly, you will also be given a daily blood thinning drug daily during your hospital stay, to prevent clots in your legs. We will teach you how to administer it yourself, as you will also need to continue this for 28 days.
How Will The COVID-19 Pandemic Affect My Surgery?
Due to the COVID-19 pandemic, we have to take certain precautions to ensure that the environment for your surgery is safe, and that the risk of COVID spread to patients and staff is kept to an absolute minimum. Please refer to the UCLH website and the admission letter for our latest guidelines.
What About Infection Control During My Hospital Stay?
Hand hygiene is the best way to prevent germs spreading. It may feel awkward to question staff when someone is looking after you, but you are entitled to ask/remind healthcare staff to wash their hands. If you have any questions with regard to infection control, please speak to your nurse.
To help reduce the risk of getting an infection in hospital, please read the following advice:
- Keep your hands and body clean.
- Always wash your hands after using the toilet.
- If you are using a commode ask for a moist wipe afterwards.
- Always wash your hands or use a moist wipe before you eat your meal.
- If a member of staff needs to examine you or perform a procedure, do not be afraid to ask if they have first washed their hands or used a hygienic hand rub or to wear gloves. Staff should wear a plastic apron and gloves for procedures such as taking blood, undertaking dressings etc.
- Keep your locker and bed table tidy and free from clutter and ensure none of your possessions are on the floor. This will make it easier for staff to clean properly.
- If you are allowed visitors, please ask them to use the hand gel provided on entering and leaving the ward.
Before your operation, we will need to obtain informed consent for your surgery. The operation will be explained and alternatives treatments available will be discussed in the clinic prior to your admission to hospital. You will also have a brief opportunity to discuss any final issues with the operating surgeon on the day of surgery before you are given your general anaesthetic. A consent form is usually signed on the day of surgery, but the risks should have already been discussed with you.
On the day of surgery, you will also meet an anaesthetist and you will be able to ask them about the anaesthetic. The surgeon and anaesthetist also need to let you know about the rare but important complications that can sometimes occur. Please make sure that you let them know if you do not understand anything they say. This is also an opportunity to ask your surgeon any other questions that you might have, no matter how trivial or stupid you think they might seem.
When you sign the consent form you are signing to say that you have had a discussion with a surgeon about your operation, and that you have had the opportunity to ask questions, regarding the things written on your form. Please note that if you sign the operation consent form it is understood that you are not signing to say that you are in agreement for any complications to occur, but accept that these things do sometimes happen during or after such a procedure.
Surgery to remove the bladder and create a new way for the body to handle urine (e.g. urostomy, neobladder) is a complex operation and things can go wrong, despite the best efforts of the surgeon and the team looking after you. Side effects and complications following surgery are common and most are not serious, but more serious complications can occur and require immediate attention and treatment.
Will My Surgery Be Performed with the Help of the Da Vinci Robot?
- Vast majority of our surgery is minimally invasive. We endeavour to perform all our operations with the assistance of the Da Vinci Robot. In other words, this is minimally invasive surgery or “key-hole surgery.” The machine is controlled by the surgeons and allows them to perform very delicate surgery through very small incisions.
- Open surgery. There are some instances where robotic surgery is not possible
– this can include patients who have had extensive abdominal or pelvic surgery in the past. This therefore requires a more traditional open incision to perform the operation. Very rarely, the surgery may start via a key-hole approach, but an incision is required to complete the surgery.
What is Performed During a Cystectomy?
- Male patients
- The typical operation in male patients with bladder cancer is to:
- Remove the bladder and prostate (these organs are attached to each other)
- Remove the lymph nodes in the pelvis (to ensure there is no cancer spread outside the bladder)
- To construct a new way for the body to handle urine (urostomy or neobladder)
- Some men who are keen for preservation of their erections may be suitable for nerve sparing.
- The typical operation in male patients with bladder cancer is to:
- Female patients
- The typical operation in female patients is to:
- Remove the bladder
- Remove part of the vagina and urethra
- Remove the lymph nodes in the pelvis
- To construct a new way for the body to handle urine (urostomy or neobladder)
- Some females may be suitable for preservation of their uterus and ovaries
- This depends on their age and also their cancer
- The typical operation in female patients is to:
How do I Know if I Will be Suitable for a Urostomy or Neobladder?
- Urostomy. This is the most common form of urinary diversion after cystectomy. This involves creating a “stoma” on the abdomen and placing a collection bag over it. It is the simplest to perform, easiest to look after, and has the lowest rate of complications. Your surgeon and specialist nurses will discuss this with you, including the pros and cons.
- Neobladder. This is a more complex form of urinary diversion, which involves creating a “bladder replacement” using the bowel. Not all patients are suitable for this, and it involves a significant amount of aftercare when patients are discharged from hospital. If you are suitable for a neobladder, the bladder cancer team will discuss this option with you, including the pros and cons.
This is important for informed consent and is a new requirement. It must be completed before your leaflet can be printed. Say what alternatives are available and in what circumstances they may be used. The risks and benefits of any alternatives must be stated. If you need help with this, please ask.
The alternatives to surgery will depend on your cancer and the stage at which it was diagnosed. Your specialist surgeon will discuss with you the alternative treatment options, but not all may be applicable in your situation.
- BCG treatment. This may be a suitable option for patients with superficial bladder cancers, who have not previously had BCG treatment. BCG (Bacille Calmette Geurin) is a form of treatment given directly to the bladder in instalments, and the duration of treatment is usually one to three years.
- Radiotherapy. This may be a suitable option for patients with a bladder cancer invading into the muscle lining of the bladder. It is less invasive than surgery and usually involves daily treatment over a period of around four weeks. Patients with muscle-invasive bladder cancer who are not fit for surgery, or prefer not to have surgery, can consider radiotherapy as an alternative. It is often combined with chemotherapy. Radiotherapy has a similar cure to surgery in most cases, but there is a higher risk of recurrence of tumour in the bladder or pelvis, compared to surgery.
- Chemotherapy. Chemotherapy is rarely given alone without being combined with either surgery or radiotherapy in patients with newly diagnosed bladder cancer that has not yet spread to other areas of the body. Some patients with metastatic (i.e. cancer that has spread to other areas of the body) may receive chemotherapy alone, with the goal of reducing the spread of the tumour.
- Surveillance. Surveillance is generally considered a last resort option, where patients are not suitable for any of the previous options. This would involve regular scans and cystoscopies to control any regrowth of the tumour in the bladder.
What Are Some of the Complications That Can Occur Following Major Surgery to Remove the Bladder?
- Cancer not being cured by surgery. This will depend on your cancer and your surgeon will discuss the risk of this with you.
- Infertility.In men, there will be a loss of the ability to father children as the ability for sperm to be carried is lost
- Loss of sexual function. In men, there will be loss of ejaculation, and loss of erections (unless suitable for nerve sparing). In females, the vaginal canal will be narrowed by surgery (unless suitable for vaginal sparing).
- Bleeding requiring transfusion. Bleeding can occur during surgery but it is uncommon for bleeding to be severe, and also uncommon to need a transfusion after surgery (UCLH risk is approx. 1.6%, lower than national average which is 4%). However, this is required in some patients, especially if their haemoglobin is low (e.g. from chemotherapy)
- Infections. Infections can occur frequently, especially urine infections, which can occur in up to one-third of patients after surgery. Some of these infections require treatment with intravenous antibiotics. Wound infections can also occur in up to 5%. Chest infections can occur in up to 5% of patients. Intra-abdominal infections can also occur in up to 5% of patients, which may require insertion of a temporary tube under local anaesthetic or sedation.
- Injury to other structures. It is very rare to injury structures in the abdomen or pelvis during the process of removing the bladder, but this can occur, especially in patients that have had previous surgery or radiotherapy. These structures include bowel, nerves and vessels.
- Injury to the rectum. The rectum is very rarely injured during surgery, and often can be repaired at the time of surgery with no ill effects. Patients who have had radiotherapy have a higher risk. If a rectal injury is severe, a temporary colostomy may be required (risk is less than 0.5%).
- Numbness. It is common for patients to have some areas of numbness in the lower abdomen or groin areas, which will usually get better with time.
What Are Some Of the Early Complications That Are Unique to Forming a Urostomy or Neobladder?
- A major part of the operation will involve using part of the bowel to form either a urostomy or neobladder. We join the ureters to the bowel, and we join the bowel back together. However, sometimes these joins will have problems
- Paralytic ileus. It is common (20-30%) for patients to have an ileus after surgery – this is where the bowels will go to sleep and stop working. If this happens, you will feel very bloated and nauseated, and you may even have a large vomit. If this happens, we will need to place a nasogastric tube to empty your stomach. We may also need to give you fluids and nutrition via the drip. This usually gets better after 48 hours
- Urine leakage. A urine leak can occur after surgery. For patients with a urostomy, this can occur where we join the ureters to the bowel (5%). For patients with a neobladder, this can occur either where we join the ureters to the bowel, or where we have done our stitching around the neobladder. A small urine leak often does not require any treatment, but a larger urine leak may require a procedure under local anaesthetic or sedation to place a temporary tube to drain the urine away from the affected area.
- Bowel leakage. It is very rare for the bowel join not to heal (1-2%), but this is very serious. This can result in an infection around the join, which can heal with bowel rest and antibiotics. However, if the infection is severe, an emergency operation may be required.
What Are Some Of the Late Complications That Are Unique to Forming a Urostomy or Neobladder?
- Despite the best efforts of the surgical team, some patients will experience problems that may not be evident for many months or years after their surgery.
- Incisional hernia. Some patients will develop a hernia through the key-hole incisions used to perform the surgery (risk is less 2%). This is where a bulge may be noted due to an internal part of the body protrudes through the incision.
- Stoma problems. This includes developing a hernia around the stoma (15-20%), or the stoma narrowing. In some cases, this may require surgery to correct.
- Nutritional problems. Vitamin, diarrhoea and nutritional problems can occur after bowel surgery, especially if large segments of the bowel are used (risk is less than 2%). We routinely monitor for these problems after your surgery.
- Scarring of the ureters. This has been reported to occur in up to 9% of patients after robotic surgery for bladder cancer, which can require further procedures to repair. We routinely monitor for this with scans after your surgery
Will You Remove The Lymph Nodes and Can This Cause Problems?
- We usually will remove the lymph nodes in the pelvis to ensure that there is no cancer spread to the lymph nodes, but your surgeon will explain to you if it is necessary in your case. In the vast majority of cases, you will not noticed that we have removed the lymph nodes.
- Lymphocele. In about 3% of cases, some lymph fluid can accumulate in the pelvis and form a cyst – sometimes, we need to perform a minor procedure under local anaesthetic to empty the cyst.
- Lymphoedema. Very rarely (1%), some patients will develop bothersome leg swelling. It is common to have leg swelling after the surgery, which will usually resolve after a few weeks. However, lymphoedema is long-lasting – the treatment for this is leg elevation, stockings, and referral to the lymphoedema service.
What Are Some of the Anaesthetic or Medical Complications That Can Occur After Major Surgery?
- Bladder cancer is typically a disease that affects older individuals, and also those with additional health problems. Compared to the rest of the UK, UCLH typically performs surgery on patients with poorer baseline health. However, this is only possible due to support from our intensive care colleagues, specialist anaesthetic colleagues, minimally invasive surgery, specialist nurses and extensive experience. Therefore, despite looking after patients with poorer baseline health function, our anaesthetic complication rates and length of stay remain lower than the national average.
- Heart attacks or strokes. Very rarely, some patients will develop a heart attack or stroke after surgery (less than 1%).
- Venous thromboembolism. Some patients will develop a clotting problem in their veins despite the measures outlined previously. This includes a deep vein thrombosis (5%) or a pulmonary embolism (3%).
- Death after surgery. Also very rarely, some patients will die within the first 30 days of surgery (The risk at UCLH is 0.43%; this is lower than the national average, which is 1.25%).
After your operation you will be transferred to the recovery area of theatres where you will stay until you are awake, comfortable, and stable. Later you will be transferred to the intensive care unit, which is done routinely after surgery for monitoring. The next day, you will be transferred to the ward to commence your recovery. After the surgery has finished, the surgeon will telephone your next of kin to inform them of how surgery went.
Monitoring
During your recovery your nurse will check you regularly because we will need to monitor the following:
- Blood pressure, pulse, respiratory rate, and temperature
- Fluid and dietary intake
- Chewing gum. You must chew one stick of gum for 15 minutes three times a day. This will help stimulate the bowel.
- Urine output and your stoma
- When your bowels start working
- Your level of pain using a pain score. This is a scale of 0-4 (0 representing no pain and 4 representing severe pain)
- The number of times you have sat out of bed
- The number of walks you have taken.
Pain Control
It is important that your pain is well controlled so that you can deep breathe, walk about, feel relaxed, and sleep well. You may have a tube in your back (an epidural) which gives you continuous pain relief and is usually removed a few days after surgery. Alternatively, you may have a pump connected to a button which you can press to administer pain killer directly into your drip (Patient Controlled Analgesia – PCA). You will also be given painkillers by mouth.
Sickness
Feeling sick (nausea) after the operation is usually caused by the anaesthetic drugs, but you will be given medicine to help reduce this. It is important that your nausea is controlled so that you can eat and drink.
Tubes and Drips
- Catheter or stents. During the operation a tube will be inserted into your new bladder or stoma so we can check that your kidneys are working well to produce adequate urine.
- Abdominal drain. A drain may be inserted into your abdomen to allow any bloody fluid from the surgery to drain away. This is usually removed a day or two after surgery by the nurse looking after you.
- The fluid drip (small tube delivering intravenous fluid) may be stopped once your fluid intake improves.
- Vaginal pack. For women, some may have a vaginal pack, which will usually be removed 24 hours after surgery. Please expect you may suffer from vaginal leakage for a few weeks post-surgery and be required to wear pads.
- Oxygen. You may be given extra oxygen to breathe after the operation until you are up and about.
Eating and drinking
Every day after your operation you will need to drink 3 nutrition drinks (unless you are diabetic). These nutrition drinks contain essential nutrients important for healing. To start with we recommend you see how you go with light meals and snacks. If you feel full or sick, then you do not have to force yourself to complete your meal. You should take a normal diet consisting of three meals a day. Special advice will be given if required.
Why Is Physiotherapy an Important Part of My Recovery?
You may be assessed by a physiotherapist after your operation. Physiotherapists assist patients with recovery by demonstrating exercises to improve breathing and facilitate mobility. Most patients can conduct their own physiotherapy exercises after their operation and these are described below for you. Deep breathing and early mobility enhance recovery after surgery. At the very least you should take a deep breath in and move all limbs every waking hour after your operation. Try these exercises out before your operation.
Breathing Exercises
Due to the effects of the anaesthetic and post-operative pain you may not be able to breathe as deeply as you normally would. You may be reluctant to move around, take a deep breath or cough forcefully. It is important to start breathing exercises as early as possible in order to clear sputum and reduce the risk of developing a chest infection. Your nurse or physiotherapist can help to guide you through the following steps after your operation.
Do the following breathing exercises while sitting upright in a chair or the bed:
- Relax the muscles of your upper chest. Breathe in and out gently through your nose. Put your hands on your lower chest and feel the rise and fall movement as you breathe.
- Take a deep breath in and hold for three seconds. Repeat this three times
- Huff: Take a medium-sized breath in followed by a short, sharp breath out, through an open mouth (similar to steaming up a mirror)
- Supported cough: Roll up a towel and use this to apply firm pressure over the wound to reduce pain during coughing.
- Practice your breathing exercises every hour when you are awake. You can start as soon as you wake up after your surgery.
Mobility and Exercise
The quicker you begin to start moving around, the quicker you may leave hospital. Your recovery starts immediately after your surgery and you will be encouraged to start mobilising as soon as you wake up.
- On the first and following days after your surgery you should sit out of bed for 2 hours each morning, afternoon and evening. You should link this to meal times as you must sit out of bed for meals.
- You should aim to walk about 60 metres three times a day with a physiotherapist or nurse accompanying you until you are judged safe to do it on your own. If you require a mobility aid or some practice on the stairs then this can be arranged. It tells you in your daily diary how far you need to walk to achieve 60m.
Other Simple Exercises
The more active you can be the quicker you can recover from your surgery and prevent complications. You can march or kick out your legs, tap your toes and reach up with your arms to optimise your circulation and muscle strength after your surgery. The third floor at Westmoreland Street has an exercise ally for patients to do gentle rehabilitation exercises
On discharge you will be given discharge information from the bladder specialist nurses, urinary diversion nurses, and a discharge letter for you and your GP.
If you are unwell and you need to be seen in hospital if at all please attend UCLH A&E Euston Road if possible. However, in the instance that you are severely unwell and require an ambulance, you make be taken to your local hospital’s A&E. However, our team can be contacted to provide advice if required. Please see contact details below.
What Symptoms Should I Expect After I Leave Hospital?
Abdominal Pain
It is not unusual to suffer griping pains (colic) during the first week after major abdominal surgery. The pain should only last a few minutes. If you have severe pain lasting for more than two hours or have a fever and feel generally unwell within two weeks of your operation date, you should contact us on the telephone numbers provided. After two weeks you should speak to your specialist nurse or GP if you have any concerns or problems.
The vast majority of patients need only paracetamol and/or anti-inflammatory medications after discharge, which is not supplied by the hospital. If you require stronger pain relief on discharge, our pharmacist will review what pain relief is required to be given to you on discharge.
Your Wound
It is not unusual for your wounds to be slightly red and uncomfortable during the first one or two weeks. Please let us know by telephone if your wounds become inflamed, painful, or swollen or start to discharge fluid.
Your Bowels
Your bowel habit may change after major abdominal surgery as your bowel has been handled during this time. Your motions may become constipated or may become loose. Make sure you eat regular meals 3 or more times a day, replace any fluid lost and take regular walks. In most patients their bowels settle down a few weeks after surgery. However, you may not go completely back to the usual bowel habit you had prior to your operation.
Passing Urine
You need to observe your urine output, should this change significantly from the time you are discharged please contact us on the above numbers. If you have a stoma you will have stents (small straw like tubes) which sit in the tubes to your kidneys draining into the stoma bag, these may fall out into the bag after about ten days, and if this does not happen we will remove them. Should they look as though they are becoming shorter (withdrawing into the body) then please contact us.
What Can I Do When I Get Home?
Diet
We recommend that you eat a balanced varied diet and particularly that you eat three or more times a day. You may find some foods upset you and cause loose motions. If this is the case avoid these foods for the first few weeks. If you are finding it difficult to eat it is still important to obtain an adequate amount of protein and calories to help your body heal. You may benefit from having high protein drinks such as Ensure Plus (not suitable for diabetics), Build-up, or Complan (available in supermarkets and chemists) to supplement your food if you are not managing your normal intake. If you are suffering from diarrhoea for more than two days seek advice from your GP. If you experience unintentional weight loss you should discuss this with your GP as you may require referral to a dietician.
Exercise and hobbies
We encourage activity from day one following surgery. You should undertake regular exercise several times a day and gradually increase this during the four weeks following your operation until you are back to your normal level of activity. Ideally this should be fore at least 30 minutes per day. The main restriction we would place on exercise is that you do not undertake heavy lifting for at least six weeks after surgery, but preferably until eight-twelve weeks after your surgery. Common sense should guide your exercise and rehabilitation. Once the wounds are pain free you can normally undertake most activities.
Work
Some people are able to return to work around six weeks following their surgery, but others may require longer. This can be discussed with your consultant as each person is different. Sick certificates can be provided by the ward during your admission. Further certificates can be provided by your GP.
Driving
You should not drive until you are confident that you can drive safely. A reasonable time for this is when you are back to most of your normal activities, which is usually at least six weeks. It is important that any pain has resolved sufficiently to enable you to perform an emergency stop and turn the wheel quickly in an emergency.
Typically, no driving is recommended for six weeks and you must comfortable doing an emergency stop. Please check with your insurance company about driving following your surgery.
When Will I Be Seen In The Outpatients Department?
When you have left hospital you will be sent an appointment to have a clinic review, which is usually four to six weeks after your discharge. This is usually a telephone appointment. At the review the doctor will discuss any histology results (the analysis of the tumour completed in the laboratory) and whether or not any further treatment will be recommended for you. Make sure that you write down any questions or concerns that you might have beforehand on a piece of paper and take this with you. After they have seen you, your doctor will dictate a letter about you to your GP
The bladder cancer team can provide you with information leaflets, as well as some online resources. You can ask our specialist nurses, urinary diversion nurses or pathway coordinator for more information.
The following resources can also be access for further information.
University College London Hospitals: https://www.uclh.nhs.uk/our-services/find-service/cancer-services/bladder- cancer/treating-bladder-cancer
British Association of Urological Surgeons: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Rad%20cyst%20m ale%20conduit.pdf
Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomized, phase 3, non-inferiority trial Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Kibel AS, Shemanski L, Pruthi RS, Montgomery JS, Weight CJ, Sharp DS, Chang SS, Cookson MS, Gupta GN, Gorbonos A, Uchio EM, Skinner E, Venkatramani V, Soodana-Prakash N, Kendrick K, Smith JA Jr, Thompson IM
Lancet. 391(10139):2525-2536, 2018 06 23.
https://
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Rad%20cyst%20m ale%20conduit.pdf
On the following pages we have written a diary that we want you to complete on the first few days after your operation. This will help guide you and hopefully get you more involved with striving to ensure a good recovery. We will ask to photocopy this diary on your discharge to help us audit and improve our service.
Please help us to improve our care for future patients. If you found something particularly helpful or particularly unhelpful or difficult during your patient journey on the Enhanced Recovery Programme then it would be much appreciated if you could let us know in writing to:
Hilary Baker
Lead CNS for Uro-oncology Mobile: 07961 109 197
Email: hilary.
Emily Campbell
Cystectomy Pathway Co-ordinator Phone: 020 3447 9485
Email: emily.
If there are any concerns about your care or you would like to speak to someone for advice, you can contact the following numbers
020 3456 3002
020 3456 3004
The ward (level 3) can be contacted on: 07930 353 227
The urology hospital is located at the following address:
University College Hospital at Westmoreland Street 16-18 Westmoreland Street
Marylebone W1G 8PH
Any correspondence can be sent to the following address:
Uro-oncology Department
47 Wimpole Street W1G 8SE
Services
Page last updated: 30 May 2024
Review due: 30 September 2024