Post-Operative Instructions for Indiana Pouch Cystectomy Patients:

Dr. Scherr has created a new bladder using a piece of your bowel.

You currently have: two stents (one light red and one light blue), a suprapubic tube (yellow rubber tube), stomach catheter (red rubber tube), urostomy bag over the suprapubic tube and stents.

Note: Since bowel tissue has been used to create a new bladder, you will notice the presence of mucous in your urine. This situation requires maintenance flushing of the suprapubic tube and foley catheter to help “thin” out these secretions and avoid blockage of the tube. We will begin having the nurses flush the suprapubic tube and foley on post operative day three (this may vary from case to case). Do not flush without Dr. Scherr’s orders.

We will begin having the nurses flush the suprapubic tube and stomal catheter on post operative day three (this may vary from case to case). Do not flush without Dr. Scherr’s orders.

Change the ostomy bag every 4 to 5 days and as needed (i.e. leaking under the wafer). The urostomy bag is temporary while the suprapubic tube and stomal catheter are in. If you need to order more bags, you can contact our New York City office, or visit Hollister Woundcare's website.

Supplies needed:

• One irrigation kit (contains 60 ml/cc irrigation syringe and basin)
• Normal saline solution/sterile water
• Paper towels

Steps for Changing the Urostomy Bag:

1. Wash hands.
2. Draw up 60 ml/cc normal saline 0.9% or sterile water into syringe.
3. Place syringe tip in stomal catheter (red rubber tube) and flush gently.
4. After flushing the stomal catheter, flush the yellow rubber suprapubic tube with 60cc x 2 (two syringes full) of normal saline solution and pull back – you should get back what you put into the tube.

Note: the irrigant should and usually will flow in the stomal catheter and out of the yellow rubber tube (suprapubic tube.

Note: Do not overfill bladder more than 60cc x 2 (two syringes full), three times a day.

Objective of flushing/irrigating is to remove the mucous – avoid blockage of tubes. Never force an irrigation or withdrawal.

On discharge:

Alert Dr. Scherr if: your temperature becomes greater than 101 degrees F, if you have chills, if nausea and vomiting are persistent, if little urine flows out of stents/tubes, difficulty irrigating stomal catheter or suprapubic tube, if there is little or no pain control, or skin breakdown. Also, if the surgical site becomes red, swells, or if there is drainage, contact Dr. Scherr immediately.

All of your tubes will eventually be removed, this is a step by step process and is individualized on a patient to patient basis.

1. Expect your stents to be removed in the office in about 1 to 2 weeks after the discharge.
2. The stomal catheter will be removed in about 2 to 3 weeks after discharge.
3. The suprapubic tube will be removed in about 3 to 4 weeks after discharge.

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