Post-Operative Instructions for Neobladder Cystectomy Patients:

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

You currently have: two stents (one pink and one blue), a suprapubic tube (yellow catheter in your abdomen), a foley catheter (tube coming from your urethra), and a urostomy bag covering the suprapubic tube and stents.

The tube in your urethra communicates with the suprapubic tube meaning both tube ends terminate or end in your newly created bladder (neobladder).

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 urostomy bag every 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.

Steps for Changing the Urostomy Bag:

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 suprapubic tube, flush the foley with 60cc x 2 (two syringes full) of normal saline/sterile water and pull back – you should get back what you put into the tube.
5. Make sure that the irrigant you instill is subtracted from the total urine output.
6. Do not irrigate the stents.

Note: the irrigant should and usually will flow through the suprapubic tube and out of the foley catheter.

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

Note: You may flush the specified amount into the tubes and notice that you are not able to remove the irrigant or see it expressed from the opposite side. If this happens, just reconnect the catheter to the drainage bag, you should see the irrigation fluid. Never force an irrigation.

Note: If irrigating the suprapubic tube you will need to deliver it outside of the urostomy bag; you may pinch off the foley and gently draw back after inserting irrigant into the suprapubic tube.

Objective of flushing/irrigating is to remove the mucous.

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 foley 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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