Preparing for a Radical Cystectomy

Once your surgery date has been scheduled, you’ll receive Your Guide to Radical Cystectomy: Preparing for and Recovering from Surgery. This booklet provides checklists for tracking each step you need to take before and after surgery, details about what to expect throughout each stage of the process, and instructions on what to do, what to bring and where to go on the day of surgery. At Johns Hopkins, we have developed an enhanced recovery after surgery critical care pathway (ERAS) which has been shown to decrease the length of stay in the hospital and improve outcomes of bladder cancer patients undergoing radical cystectomy.

Prior to Surgery

There are several options for urinary diversion, and your survivorship experience will likely differ depending on which procedure and which urinary diversion you choose. Our multi-disciplinary team of surgeons, nurse practitioners, and ostomy nurses partner with each patient to provide information about urinary reconstruction.

In the weeks leading up to surgery, you will be directed to watch videos and review patient education materials. You’ll get bloodwork and other tests as necessary, prepare medical records and medication lists, gather bowel and skin prep supplies, and meet with your care team, which includes your surgeon and specially trained ostomy nurses who guide each patient about how to live with and improve your quality of life with a urostomy.

Surgery and Hospital Stay

Before Surgery

After checking in two to three hours before your scheduled surgery, you’ll go to the pre-surgery area with one member of your family, if desired. Here, nurses and anesthesia providers will make sure everything is all set for surgery. You’ll receive an IV and several medications to manage pain and nausea during and after surgery. If appropriate, an epidural will be administered as an alternative to narcotics.

In the Operating Room

Just before surgery, you will be connected to monitors, given blood thinners to prevent clots if needed, and given antibiotics to prevent infection. Then, the anesthesiologist will put you to sleep with a general anesthetic. Usually, surgery takes four to six hours. The OR nurse and recovery team will update your family periodically during this time.

After Surgery

After you’re awake and stable, you’ll spend a few hours in the recovery room and then be reunited with your family at your hospital bed on the urology surgical unit. Visiting hours are 24/7, and reclining chairs are available for visitors who wish to stay overnight. You’ll begin a clear liquid diet and will receive regular checkups from the nursing staff. Patients are encouraged to hydrate, and get up and moving after their surgery as soon as they are able. Patients who follow the "Enhanced Recovery After Surgery" protocols are known to be discharged sooner, have better outcomes, and have a less lengthy hospital stay.

Discharge

We aim to have patients stay in the hospital for four to five days, but they often require additional time before it’s safe to discharge. Hydration, pain, bowel function and mobility are considered when determining whether you’re ready to go home. If complications like nausea, ileus (bowel shutdown) or infection are present, your stay may be prolonged.

When you are approved to leave, you’ll receive detailed discharge instructions to prepare you for home recovery. In many cases, patients are followed with a few in-home care visits for follow-up from trained nurses to assure that patients recover fully from their surgery.

Life After Surgery

First Few Weeks

Because radical cystectomy involves making new connections on the bowel, you may experience unpredictable bowel function following surgery, meaning either loose bowels or constipation. Most patients will get back to normal with time. Nutritious meals, staying hydrated and regular walks are important.

You’ll be given instructions for eating a healthy post-surgery diet, caring for wounds, and identifying signs of infection or other concerns.

Getting Back to Normal

• Exercise – We encourage walking after surgery and gradually increasing activity levels until you’re back to your normal level, at around four weeks postop. Many people will feel fatigued and require a daily nap, which is normal.
• Work – You should be able to return to work in four to six weeks.
• Driving – Most patients are ready to drive three to four weeks after surgery, once they are off narcotics and pain-free enough to react quickly.

Survivorship

The Greenberg Bladder Cancer Institute's website features resources, webinars, and support group offerings for bladder cancer patients who have undergone surgery.

The Bladder Cancer Advocacy Network has a range of informative and inspirational videos and webinars to help you understand what life can be like following a radical cystectomy.

For more information about life after bladder cancer, see our bladder cancer survivorship resources.