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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Genitourinary

Neobladder Continent Urinary Diversion (5787)

Neobladder Continent Urinary Diversion (5787) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Genitourinary

5787







Neobladder
Continent Urinary Diversion















Table of Contents

Neobladder – Continent Urinary Diversion .................................................................................................. 1
Normal Urinary Tract ................................................................................................................................ 1
What is a neobladder? .............................................................................................................................. 2
How is the neobladder made? .................................................................................................................. 2
How does the neobladder work? .............................................................................................................. 2
Preoperative Exam ........................................................................................................................................ 2
Getting Ready For Surgery ............................................................................................................................ 3
After Surgery ................................................................................................................................................. 3
Incision, Drains, and Tubes ....................................................................................................................... 4
Going Home .............................................................................................................................................. 4
Home Care .................................................................................................................................................... 5
Diet and Fluid Intake ................................................................................................................................. 5
Activities .................................................................................................................................................... 5
Mucus Management ................................................................................................................................. 6
When to Call the Doctor ............................................................................................................................... 6
MEDICAL ALERT BAND .................................................................................................................................. 7
Follow-Up ...................................................................................................................................................... 8
Phone Numbers ............................................................................................................................................ 8








1

Neobladder – Continent Urinary Diversion
Normal Urinary Tract
The normal urinary tract consists of two kidneys, two ureters, the bladder and the urethra. The
kidneys are toward your back at about the waist level. They make urine filter the blood and
remove waste from the body. Urine from each kidney is carried to the bladder by tubes called
ureters. The bladder is an organ made of muscle that stores urine. The urethra is the channel
that carries urine from the bladder to the outside of the body.




What is a Radical Cystectomy?
Radical cystectomy is the surgical removal of the bladder. The prostate gland is also
removed in men. The uterus is also removed in women.




2

How do I get rid of urine after the bladder is removed?
After the bladder is removed, a urinary diversion is made using a piece of your bowel. This
can be done in different ways depending on your medical history, age, lifestyle, and how
able you are to care for yourself after surgery.

What is a neobladder?
A neobladder replaces the bladder by using part of the large bowel. A new bladder is made from
a piece of the large bowel and attached to the neck of the urethra. It will store your urine and
allow you to urinate through the urethra much like you did before your surgery.
How is the neobladder made?
The first step is to remove the bladder. In men, the prostate is almost always removed along with
the bladder, while the uterus is often removed in women. The neobladder is made from part of
the bowel and joined to the neck of the urethra. A sample (biopsy) of the neck of the bladder and
the urethra is taken to check for cancer. If cancer is present, the neobladder will not be possible.
Instead, you may need to have an Indiana pouch or an ileal loop. Sometimes, other factors (scar
tissue, anatomic reasons) prevent the make of the neobladder.
How does the neobladder work?
The neobladder functions like your own bladder. Urine drains into the neobladder, then empties
through the urethra when you strain or contract your abdominal muscles. This increases the
pressure with the neobladder causing it to empty. Over time, the neobladder stretches and you
will be able to hold more urine. It may take you weeks to months to be able to store urine
without leakage. To stay dry, you may need to wake up to urinate at night.
Preoperative Exam
For your preoperative exam visit, a provider (nurse practitioner, physician, or physician
assistant) will perform a complete health history and physical exam. You will have urine and
blood tests, a chest X-ray and an EKG. You may also need to visit the anesthesia screening
clinic.
A nurse will explain how to get ready for your surgery. A nurse will also mark your abdomen.
This is done in case your doctor decides during surgery that a pouch or loop is needed instead of
a neobladder.
Please eat before you go for your work-up visit since it may take 4 to 6 hours.

3

Getting Ready For Surgery
ξ Depending on your surgeon, you may need a bowel prep before your surgery. This
will be discussed with you by your surgical team.
ξ Do not eat or drink anything after midnight!!
After Surgery
Plan to be in the hospital for 7 to 10 days.
We will help you to start walking the day after your surgery. Getting up and walking early are
the best ways to speed your recovery. Walking helps to prevent problems such as a bowel
obstruction, pneumonia or blood clots. Expect to walk in the hall 3-4 times a day. Pain
medicine may make it easier for you to move around.















4

Incision, Drains, and Tubes
Incision: You will have an incision down the middle of your abdomen. This makes it easier for
the doctor to remove your bladder. Staples are used to hold the incision together. They will be
taken out in 7-10 days. You may have a small amount of drainage from your incision. It will be
cleaned and the dressing changed daily and as needed.
Drains and Tubes
ξ You will have an intravenous line (IV) to give you fluids.
ξ You may have oxygen on.
ξ NG (Nasogastric) Tube: You will have a tube in your nose going to your stomach to help
prevent nausea and vomiting until your bowel starts to work again (about 3-5 days). You
will not eat or drink by mouth while the tube is in place.
ξ You may have TED hose and leg wraps (Venodynes) on your legs to prevent blood clots
in your legs.
ξ A Foley catheter will be placed in the space where your bladder was. This is a tube
placed through your urethra to protect the healing of the suture lines that join the urethra
and the neobladder. It is taken out about 3-4 weeks after surgery. It takes this much time
for the neobladder to heal.
ξ You will have a soft, long rubber drainage tube called Jackson-Pratt (JP)drain which are
brought out through the skin on one side of your abdomen. JP drains are used to drain
old blood and fluid from around your neobladder. This helps to prevent infection.
Nurses will measure the drainage. Your doctor will remove the drains after the drainage
has stopped, most often within 2-3 days.
ξ You will have a suprapubic catheter. This is a tube placed through your abdominal wall
into the new bladder to keep it drained. It is removed in about 2-3 weeks.
ξ You will have two small hollow tubes called stents (one for each kidney) to drain the
urine from the kidneys while your neobladder is healing. The stents allow the urine to
flow freely. The ends are brought to the outside through a small opening on your
abdomen. They are connected to a drainage bag at the side of your bed. You will go
home with the stents in place. They will be taken out when you come for your first clinic
visit.
Going Home
While in the hospital, nurses will teach you how to care for your tubes. You will learn how to
flush the catheters every 4 hours and as needed to help prevent blockage. Because the
neobladder is made out of bowel, it secretes mucus. This can plug the catheters.
After your Foley is removed, you will be taught how to pass urine by straining the abdominal
muscles. You will be asked to follow a schedule for the first six weeks. You will need to urinate

5

at set times. This will help to gradually expand the neobladder to hold greater volumes of urine
and promote dryness.
The time it takes you to control the neobladder can vary. Most often, nighttime leaking is the
last to recover. You may be taught to do pelvic exercises. These will help you to stay dry. You
may need to perform 15-20 sets of pelvic exercises once or twice a day as you are able.
You may need to use adult diapers or other devices. If needed, you will be taught how to
catheterize yourself since abdominal straining may not be enough to empty urine from the
neobladder.
Voiding Routine
Week s 1-3: Every 2 hours during the day
Every 3 hours at night
Weeks 3-6: Every 3 hours during the day
Every 4 hours at night
After week 6: Every 4 hours during the day
At night, void as needed.

The goal is to void every 4 hours. Do not worry if you are not able to wait for 4 hours. If your
urine output is greater than 500mL each time, you will need to void more often. If your bladder
feels full and you are not able to empty your bladder, you will have to catheterize yourself. You
must not wait longer than six hours before you empty your bladder.
Home Care
Diet and Fluid Intake
Eat a regular diet as you are able. Some foods such as spicy foods, asparagus, fish, eggs,
medicines, and vitamins, can change the smell or color of your urine. You should drink at least 2
liters of fluids per day. A high urine output will help you to keep the neobladder flushed and
reduce your risk of infection. High fluid intake also reduces the risk of forming kidney or
neobladder stones.
Activities
ξ You may shower or take sponge baths. Do not take tub paths until you get permission
from your surgical team.
ξ No straining or lifting over 10 pounds for 4-6 weeks.
ξ You may drive after 4 weeks.
ξ Avoid contact sports for 4 to 6 weeks, or until your doctor tells you it is safe.

6

ξ Swimming is okay after 6 weeks.
ξ You may resume sexual activity as soon as you are ready.
ξ Plan on being off work for 6-8 weeks.
Mucus Management
Flush your neobladder every morning, evening, and as needed. This will break up and flush out
mucus that can block the tube. One of the first signs of blockage (obstruction) is a decrease in
urine output.
Supplies Needed
ξ Normal saline solution or sterile water
ξ Bulb or piston syringe
Procedure/Steps
ξ Gather your supplies.
ξ Wash and dry your hands.
ξ Use alcohol swab to clean the catheter and syringe as shown to you.
ξ Draw up 30-60 mL of saline or sterile water into the syringe.
ξ Clamp the Foley Catheter. Using the syringe, gently flush the solution through the
suprapubic catheter into the neobladder. Do not force it.
ξ Gently withdraw or pull back any solution and mucus through the syringe, or allow it to
drain by gravity into a toilet.
ξ Then flush 30-40 mL into the suprapubic catheter and unclamp the Foley catheter and
allow it to drain. Alcohol swab the suprapubic tube and drainage bad and connect back
together.
ξ Now clamp the suprapubic catheter and flush 30-60 mL into the Foley catheter. Gently
withdraw any solution and mucus through the syringe, or allow to drain by gravity into a
toilet.
ξ Flush gently until urine is free and clear of mucus.
When to Call the Doctor
ξ Fever over 100.5 degrees F when taken by mouth for two readings taken 4 hours apart
ξ Shaking chills or sweating.
ξ Decreased or no urine output.
ξ Pink, red, cloudy and/or foul-smelling urine.
ξ Redness, warmth, swelling or pus-like drainage at incision line.
ξ Loss of appetite.

7

ξ Nausea and vomiting.
ξ Diarrhea that lasts more than a few days.
ξ Abdomen, back, or flank pain.
ξ Leg swelling or calf tenderness.
MEDICAL ALERT BAND
You should always wear a medical alert bracelet or necklace on you at all times. This will alert
healthcare providers that you have a neobladder. It should read:
Neobladder – Continent Urinary Diversion
May catheterize 4-6 times a day with a #16 catheter
Ask your doctor or nurse for a form, or order the Medical Alert band from:
Medical Alert Foundation
2323 Colorado Avenue
Turlock, CA. 95382
1-800-432-5378
www.medicalert.org









8


Follow-Up
You will be followed by your surgical team (doctor, nurse practitioner or physician assistant).
Your follow-up visits should be at 1 week, 2 weeks, 3 weeks, 3 months, 6 months, and yearly. You may
need to have more tests after your surgery to include urine and blood tests, ultrasound, CAT scan, chest x-
ray, or a pouchogram (a special X-ray of the new bladder). Your first postoperative visit will be made for
you before you leave the hospital. Please call your doctor with any questions or concerns.
Phone Numbers
Urology clinic Nursing Staff (608) 263-4757 Monday-Friday 8:00 AM – 4:30 PM
After hours, nights, weekends, and holidays, please call (608)262-0486. This will give you the paging
operator. Ask for the urology doctor on call. Give the operator your name and phone number with the
area code. The doctor will call you back.
If you live out of the area, please call 1-800-323-8942 to reach the paging operator.
Your Urology Doctor is: ________________________________
















Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©2/2016. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5787