This guide will help you get ready for your bladder surgery with a continent cutaneous diversion at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.
Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.Back to top
About your surgery
Your urinary system is made up of organs that make urine and get it out of your body (see Figure 1).
- Your kidneys clean the toxins out of your blood and make urine.
- Your ureters are tubes that carry urine from your kidneys to your bladder.
- Your bladder stores urine until you feel the need to urinate.
- Your urethra is a tube that carries the urine in your bladder out of your body when you urinate.
- In women, the urethra is very short. It’s located above the vagina.
- In men, the tube is longer. It passes through the prostate gland and penis.
Removing your bladder
Surgery to remove your entire bladder is called a radical cystectomy.
During your surgery, your doctor will remove your bladder and some of the lymph nodes near your bladder. Then, they’ll rebuild your urinary system.
About lymph nodes
Lymph nodes are small, bean-shaped glands that are located throughout your body. They’re part of your lymphatic system, which is part of your body’s immune system. Lymph nodes are removed during your surgery because they may also contain cancer cells.
If you’ve had surgery or radiation therapy to your pelvis in the past, your doctor may remove fewer lymph nodes. This is done to avoid problems after your surgery.
Removing other organs near your bladder
In addition to your bladder and lymph nodes, your doctor may need to remove other organs near your bladder. This is done to make sure all of the cancer is removed.
In men, the following organs may be removed:
- Seminal vesicles
- Part of the vasa deferentia
In women, the following organs may be removed:
- Fallopian tubes
- Part of the vagina
Creating your continent cutaneous diversion
After your bladder is removed, your doctor will create a new pouch to hold your urine. This is called a urinary diversion. The type you’ll have is called a continent cutaneous diversion.
Your doctor will use a small piece of your colon (large intestine) to create your continent cutaneous diversion. One end of the pouch will be attached to your ureters. The other end will be attached to a small opening in your abdomen called a stoma. Your doctor will create the stoma during your surgery. They’ll also create a valve to keep urine from flowing out of the stoma. You won’t need to wear anything outside of your body to catch the urine.
After your surgery, your urine will flow from your kidneys, through your ureters, and into your pouch. To empty your pouch, you’ll put a catheter (thin, flexible tube) through your stoma several times a day. You’ll learn how to do this after your surgery.
This surgery usually takes about 4 to 7 hours. It may take longer if you have other medical conditions or have had past surgeries.Back to top
Before Your Surgery
The information in this section will help you get ready for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.
Write down your questions and be sure to ask your healthcare provider.
Getting ready for your surgery
You and your healthcare team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Jantoven®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your healthcare provider knows all the medications you’re taking.
- I take prescription medications (medications prescribed by a healthcare provider), including patches and creams.
- I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
- I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
- I’m allergic to certain medication(s) or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you can’t stop drinking.
- Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.
If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. If you smoke, your healthcare provider will refer you to our Tobacco Treatment Program. You can also reach the program by calling 212-610-0507.
About sleep apnea
Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.
About Enhanced Recovery After Surgery (ERAS)
ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.
Before your surgery, make sure you’re ready by doing the following things:
- Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next appointment, or you can call their office.
- Exercise and follow a healthy diet. This will help get your body ready for your surgery.
After your surgery, help yourself recover more quickly by doing the following things:
- Read your recovery pathway. This is a written educational resource that your healthcare provider will give you. It has goals for your recovery and will help you know what to do and expect on each day during your recovery.
- Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.
Within 30 days of your surgery
Presurgical Testing (PST)
Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment.
During your appointment, you’ll meet with a nurse practitioner (NP) who works closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
It’s very helpful to bring the following things to your PST appointment:
- A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your healthcare provider(s).
Identify your caregiver
Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.
Complete a Health Care Proxy form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.
Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.
Do breathing and coughing exercises
Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer. If you have any questions, ask your healthcare provider.
Consider our sexual health programs
Bladder surgery will affect your sexual health. If you have any concerns about how it will affect you, think about making an appointment with one of our sexual health clinics.
Information for men
Bladder surgery can cause changes in erectile function (your ability to get and keep an erection). Most men have erectile dysfunction (ED) after surgery. ED is when you have trouble getting or keeping an erection.
Your healthcare provider will talk with you about what to expect about having erections again after surgery. There are many types of treatments for ED, including pills, injections (shots), or a prosthesis (implant). Your healthcare provider can talk with you about these options.
Because your prostate will be removed during your surgery, you won’t be able to father children after your surgery. If you want to have children in the future, you may want to bank your sperm before surgery. Ask your healthcare provider for information about sperm banking if you want to bank your sperm.
Information for women
If your reproductive organs are removed, you won’t be able to bear children after your surgery. If you want to have children in the future, you may want to think about family planning options (such as egg freezing) before your surgery. Your healthcare provider can discuss these options with you.
You may also have changes in sexual function after your surgery. These may include a shorter vagina and menopause. Menopause is when you no longer have a menstrual period. Your healthcare provider will talk with you about what to expect. They can also discuss your treatment options with you in more detail.
Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.
For more information about exercising, read the resource General Exercise Program: Level 2.
Follow a healthy diet
Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.
Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)
4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.
Buy magnesium citrate
Magnesium citrate is an over-the-counter laxative. Taking magnesium citrate before your surgery will help make sure your colon is empty during your surgery.
Buy 3 (10-ounce) bottles of magnesium citrate. You can buy it at your local pharmacy without a prescription.
Buy clear liquids
You’ll need to follow a clear liquid diet before your surgery. It’s helpful to buy clear liquids ahead of time. For a list of clear liquids you can drink, read the section “Follow a Clear Liquid Diet.”
7 days before your surgery
Follow your healthcare provider’s instructions for taking aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
Stop taking NSAIDs, such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
Drink magnesium citrate
At 8:00 am 2 days before your surgery, drink 1 (10-ounce) bottle of magnesium citrate.
- You’ll probably start having bowel movements within 30 minutes. However, it can take as long as 3 hours before bowel movements start. Make sure to stay close to a toilet during your bowel preparation.
- Apply petroleum jelly (Vaseline®) or vitamin A&D ointment (A+D® Ointment) to the skin around your anus after every bowel movement. This helps prevent irritation.
- Drink clear liquids all day until bedtime. You should drink clear liquids at your usual meal times and between meals.
Start following a clear liquid diet
You’ll need to start following a clear liquid diet 2 days before your surgery. A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear Liquid Diet” table.
While you’re following this diet:
- Don’t eat any solid foods.
- Try to drink at least 1 (8-ounce) glass of clear liquid every hour while you’re awake.
- Drink different types of clear liquids. Don’t just drink water, coffee, and tea. You can drink liquids of any color.
- Don’t drink sugar-free liquids unless you have diabetes and a member of your healthcare team tells you to.
For people with diabetes
If you have diabetes, ask the healthcare provider who manages your diabetes what you should do while you’re following a clear liquid diet.
- If you take insulin or another medication for diabetes, ask if you need to change the dose.
- Ask if you should drink sugar-free clear liquids.
While you’re following a clear liquid diet, make sure to check your blood sugar level often. If you have any questions, talk with your healthcare provider.
|Clear Liquid Diet|
|Drink||Do Not Drink|
1 day before your surgery
Follow a clear liquid diet
Keep following a clear liquid diet the day before your surgery. If you have diabetes, remember to check your blood sugar level often. Follow any other instructions that the healthcare provider who manages your diabetes gave you.
Drink magnesium citrate
At 8:00 am on the day before your surgery, drink 1 (10-ounce) bottle of magnesium citrate.
- Make sure to stay close to a toilet during your bowel preparation.
- Apply petroleum jelly or vitamin A&D ointment to the skin around your anus after every bowel movement.
- Keep drinking clear liquids all day until bedtime. Drink clear liquids at your usual meal times and between meals.
At 2:00 pm, if your bowel movements aren’t clear, drink another (10-ounce) bottle of magnesium citrate.
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.
The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.
This will be the following location:
Presurgical Center (PSC) on the 6th floor
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
B elevator to 6th floor
Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)
The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.
- Use your normal shampoo to wash your hair. Rinse your head well.
- Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
- Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
- Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
- Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
- Dry yourself off with a clean towel after your shower.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Go to bed early and get a full night’s sleep.
Instructions for eating before your surgery
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
The morning of your surgery
Instructions for drinking before your surgery
Finish the ClearFast preop® drink your healthcare provider gave you 2 hours before your scheduled arrival time. Do not drink anything else, including water.
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Remove nail polish and nail wraps.
- Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
- If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.
What to bring
- A pair of loose-fitting pants (such as sweat pants).
- Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can fit over this swelling.
- Your breathing device for sleep apnea (such as your CPAP device), if you have one.
- Your incentive spirometer, if you have one.
- Your Health Care Proxy form and other advance directives, if you completed them.
- Your cell phone and charger.
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.
Where to park
MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.
To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once you’re in the hospital
You’ll be asked to say and spell your name and date of birth many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.
Get dressed for surgery
When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room.
Marking your surgical site
In addition to being asked your name and birth date, you may also be asked the name of your doctor, what surgery you’re having, and which side is being operated on. Your doctor or another member of your surgical team will use a marker to initial the site on your body that will be operated on. This is for your safety. We do this to make sure all members of the surgical staff are clear about the plan for your surgery.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer your questions about your anesthesia.
Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give pain medication.
Get ready for your surgery
When it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles, if you have them.
You’ll either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe.
Once your surgery is finished, your incision will be closed with staples, sutures (stitches), or Dermabond® (surgical glue). You’ll also have a bandage over your incision. Your breathing tube is usually taken out while you’re still in the operating room.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.
Write down your questions and be sure to ask your healthcare provider.
In the Post-Anesthesia Care Unit (PACU)
When you wake up after your surgery, you’ll be in the Post-Anesthesia Care Unit (PACU).
A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs.
Tubes and Drains
You’ll have several different types of drainage tubes in your body. Your healthcare provider will talk with you about what to expect. You’ll have 1 or more of the tubes and drains below.
- Jackson-Pratt® (JP) drain: This is a small egg-shaped container that’s connected to a tube in the lower part of your abdomen. It drains liquid from your pelvis.
- Stents: These are 2 small tubes. They may be in a small opening in your abdomen, or they may be attached to a drainage tube inside your body. They drain urine from your kidneys.
- Drainage tube in your abdomen: This is a tube in the lower part of your abdomen. It drains urine from your pouch. It may be called a suprapubic (SP) tube or a cecostomy tube.
- Drainage tube in your pouch: This is a tube in your stoma. It drains urine from your pouch.
You’ll get epidural or IV pain medication while you’re in the PACU.
- If you’re getting epidural pain medication, it will be put into your epidural space (the space in your spine just outside your spinal cord) through your epidural catheter. You’ll be able to control your pain medication using a button called a patient-controlled analgesia (PCA) device. For more information, read the resource Patient-Controlled Analgesia (PCA).
- If you’re getting IV pain medication, it will be put into your bloodstream through your IV line.
If you don’t have an epidural catheter, you’ll get pain medication through your IV line.
Moving to your hospital room
You’ll probably stay in the PACU overnight. After your stay in the PACU, a staff member will take you to your hospital room.
In your hospital room
The length of time you’re in the hospital after your surgery depends on your recovery. Some people leave after 3 to 4 days, while other people stay longer. Your nurse will teach you how to recover after your surgery.
Read the resource Call! Don't Fall! to learn about what you can do to stay safe and keep from falling while you’re in the hospital.
Moving around and walking
Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed. They’ll also give you medication to relieve pain.
Try to follow the moving and walking goals below. These goals are also in your recovery pathway.
|Moving and Walking Goals|
|The day of surgery||
|1 day after surgery||
|2 days after surgery||
|3 days after surgery||
|4 days after surgery||
Managing your pain
You’ll have some pain after your surgery.
- If you have an epidural catheter, you’ll get pain medication into your epidural space. You’ll be able to control your medication using a PCA device.
- If you don’t have an epidural catheter, you’ll get pain medication in your IV line.
- Once you’re able to eat normal food, you’ll get oral pain medication (medication you swallow).
Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.
If you had a robotic surgery, you may have pain in your shoulder. This is called referred pain. It’s caused by the gas that was put into your abdomen during your surgery, and it’s normal. If you have pain in your shoulder, tell one of your healthcare providers. They’ll bring you a hot pack to put on your shoulder to help with the pain.
You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications.
Exercising your lungs
It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.
- Use your incentive spirometer 10 times every hour you’re awake. For more information, read How to Use Your Incentive Spirometer.
- Do coughing and deep breathing exercises. A member of your care team will teach you how to do them.
When using your incentive spirometer or doing other breathing exercises, it may help to hold a pillow or blanket against your incision. This will keep your muscles from moving as much.
You may be able to start drinking liquids the day after your procedure. Depending on how your bowels are working, you’ll slowly start eating solid foods again over the next few days.
While you’re recovering, your appetite may be smaller than it was before your surgery. Eat several small meals throughout the day instead of 3 large meals. Eating this way will help your digestion and give you energy throughout the day.
Swelling and discharge
Right after surgery, you may have some swelling in your genitals and groin. You may also have some discharge from your penis or vagina. This is normal. The swelling and discharge should go away over a few weeks.
You’ll be able to shower with help 3 days after your surgery.
Learning to care for your continent cutaneous diversion
While you’re in the hospital, your nurse will teach you how to care for your continent cutaneous diversion. They’ll also teach you how to care for any tubes or drains you’ll have at home.
You’ll also have a case manager after your surgery. They’ll work with you to arrange for a home care nurse to visit you after you’re discharged from the hospital.
Getting your supplies
Before you leave the hospital, your nurse will give you enough supplies to care for yourself at home for about 3 weeks. They’ll also give you a list of companies you can contact to order more supplies. The nurse who works with your doctor will also help you order more supplies after you’re discharged.
A home care nurse will visit you when you’re home from the hospital. They’ll keep track of how you’re recovering. They’ll also help you practice caring for your continent cutaneous diversion.
The nurse that works with your doctor will call you 1 to 4 days after you’re discharged to see how you’re doing. They’ll also tell you when to schedule your first appointment after surgery.
Read the resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and keep from falling at home and during your appointments at MSK.
You should always wear a MedicAlert bracelet or necklace that states that you had a cystectomy with a continent cutaneous diversion. This will help emergency services workers care for you if you’re ever seriously ill or hurt and need medical help.
You can buy a MedicAlert bracelet or necklace at most drug stores, or you can ask your nurse for an application. For more information, visit the MedicAlert website at www.medicalert.org.
Caring for your drainage tube(s)
You’ll leave the hospital with 1 or more drainage tubes. The tube(s) will drain urine from your pouch and help the area heal.
Your continent cutaneous diversion is made out of a piece of your intestine, and your intestine makes mucus. You’ll need to irrigate the tube(s) in your pouch before and after you leave the hospital to make sure they don’t get clogged with mucus. Your nurse will teach you how to do this, and a home care nurse will help you after you’re discharged. You’ll need to irrigate your tube(s) until they’re removed.
After the tube(s) are removed, you’ll see mucus in your urine. This is normal. With time, your continent cutaneous diversion will make less mucus.
Emptying your pouch
After the drainage tubes are removed from your pouch, you’ll need to empty it on a schedule. This will help you keep from overfilling your pouch. Below is an example of a schedule for emptying your pouch for the first 2 weeks after the drainage tubs are removed. Your healthcare provider may tell you to follow a different schedule. Follow their instructions.
|Schedule for Emptying Your Pouch|
|Week 1||Every 2 hours||Every 3 hours|
|Week 2||Every 3 hours||Every 4 hours|
At nighttime, set an alarm clock to wake you up once in the middle of the night to empty your pouch.
Around 2 weeks after the drainage tubes, you’ll have a follow-up appointment. Your healthcare provider will talk with you about your schedule for emptying your pouch during this appointment.
Managing your pain
The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean that something is wrong.
Follow the guidelines below to help manage your pain at home.
- Take your medications as directed and as needed.
- Call your healthcare provider if the medication prescribed for you doesn’t ease your pain.
- Don’t drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy. Alcohol can make the drowsiness worse.
- As your incision heals, you’ll have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will ease aches and discomfort.
- Follow your healthcare provider’s instructions for stopping your prescription pain medication.
- Don’t take more of any medication than the amount directed on the label or as instructed by your healthcare provider.
- Read the labels on all the medications you’re taking, especially if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. But, taking too much can harm your liver. Don’t take more than 1 medication that contains acetaminophen without talking with a member of your healthcare team.
- Pain medication should help you resume your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
- Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.
Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).
Preventing and managing constipation
Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.
- Go to the bathroom at the same time every day. Your body will get used to going at that time. But, if you feel like you need to go, don’t put it off.
- Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. The reflexes in your colon are strongest at this time.
- Exercise, if you can. Walking is an excellent form of exercise.
- Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices (such as prune juice), soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine (such as coffee and soda) pull fluid out of your body.
- Slowly increase the fiber in your diet to 25 to 35 grams per day. If you have an ostomy or have had recent bowel surgery, check with your healthcare provider before making any changes in your diet. Foods high in fiber include:
- Whole-grain cereals and breads
- Unpeeled fruits and vegetables
- Mixed green salads
- Apricots, figs, and raisins
- Both over-the-counter and prescription medications are available to treat constipation. Check with your healthcare provider before taking any medications for constipation, especially if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medications for constipation include:
- Docusate sodium (Colace®). This is a stool softener (medication that makes your bowe; movements softer) that causes few side effects. You can use it to help prevent constipation. Don’t take it with mineral oil.
- Polyethylene glycol (MiraLAX®). This is a laxative (medication that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
- Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
For more information, read the resource Constipation.
Call your healthcare provider if you aren’t passing gas or if you haven’t had a bowel movement in 3 days.
Diarrhea and other changes in bowel function
When part of your colon is removed, the part that’s left adapts to the change. Your colon will start to adapt soon after your surgery. During this time, you may have gas, cramps, or changes in your bowel habits (such as diarrhea or frequent bowel movements). These changes may take weeks to months to go away.
If you’re having problems with changes in your bowel function, talk with your healthcare provider. You can also try the tips below.
Tips for managing gas
If you have gas or feel bloated, avoid foods that can cause gas. Examples include beans, broccoli, onions, cabbage, and cauliflower.
Tips for managing diarrhea
If you have diarrhea, it’s important to drink at least 8 to 10 (8-ounce) glasses of liquids every day. Drink water and drinks with salt, such as broth and Gatorade®. This will help you keep from becoming dehydrated and feeling weak.
Following the BRATY diet can also help control diarrhea. The BRATY diet is made up mostly of:
- Bananas (B)
- Rice (R)
- Applesauce (A)
- Toast (T)
- Yogurt (Y)
If you’re having diarrhea more than 4 to 5 times a day, or if it smells worse than normal, call your healthcare provider.
Tips for managing soreness
If you have soreness around your anus:
- Soak in warm water 2 to 3 times a day.
- Apply zinc oxide ointment (such as Desitin®) to the skin around your anus. This helps prevent irritation.
- Don’t use harsh toilet tissue. You can use a nonalcohol wipe (such as a baby wipe) instead.
- Take medication, if your healthcare provider prescribes it.
Caring for your incision
Take a shower every day to clean your incision. Follow the instructions in the “Showering” section below.
It’s normal for the skin below your incision to feel numb, because some of the nerves were cut. The numbness will go away over time.
Call your healthcare provider if:
- The skin around your incision is very red.
- The skin around your incision is getting more red.
- You see drainage that looks like pus (thick and milky).
If you go home with staples in your incision, they’ll be removed during your first appointment after surgery. It’s okay to get the staples wet.
Take a shower every day to clean your incision. If you have staples in your incision, it’s okay to get them wet.
Use soap, but don’t put it directly on your incision. Don’t rub the area around your incision. After you shower, pat the area dry with a clean towel. Leave your incision uncovered or cover it with a small bandage if your clothing may rub it (such as the waistline of your pants).
Don’t take a bath for the first 4 weeks after your surgery.
Eating and drinking
You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.
For more tips on eating more calories and protein, read the resource Eating Well During Your Cancer Treatment.
It’s important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day. You should drink enough so that the urine in your pouch is very light yellow or clear. If it becomes dark yellow or orange, you need to drink more.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Activities and exercise
When you leave the hospital, your incision will look like it’s healed on the outside, but it won’t be healed on the inside.
- Don’t lift anything heavier than 10 pounds (about 4.5 kilograms) for at least 6 to 8 weeks after your surgery.
- Don’t do any demanding activities (such as jogging, tennis, or contact sports) for at least 3 months after your surgery.
Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center. For more information, read the resource General Exercise Program: Level 2.
It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.
Ask your healthcare provider when you can drive. Most people can start driving again within 6 weeks after surgery. Don’t drive while you’re taking pain medication that may make you drowsy. You can ride in a car as a passenger at any time after you leave the hospital.
Going back to work
Having a continent cutaneous diversion shouldn’t stop you from going back to work. Talk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.
You’ll be able to travel. Here are some suggestions for when you travel:
- Bring extra supplies, just in case it’s hard to get them at your destination.
- If you’re taking a plane, train, or bus, carry your supplies with you. Don’t put them in your checked luggage. This will help you be prepared if you’re separated from your luggage.
Sexuality includes many aspects of caring and closeness. It isn’t only having sex. You and your partner can build other forms of sexual and emotional expression. Most important, remember that your surgery doesn’t change your feelings for each other. Sexual counseling to talk about these issues can help. Any member of your healthcare team can refer you to counseling.
The American Cancer Society (ACS) offers free booklets on cancer and sexual health called Sex and the Man With Cancer and Sex and the Woman With Cancer. You can get copies by calling 800-ACS-2345 (800-227-2345) or visiting the ACS website, www.cancer.org.
MSK’s Male Sexual & Reproductive Medicine Program
After surgery, men will have erectile dysfunction (ED). There are treatments to help with this. We recommend that men see a specialist in the Male Sexual & Reproductive Medicine Program. You can make an appointment by calling 646-888-6024.
MSK’s Female Sexual Medicine & Women’s Health Program
After surgery, women won’t able to bear children if their reproductive organs were taken out. Some women may also have changes in the structure of their vagina. We recommend that women see a specialist in the Female Sexual Medicine & Women’s Health Program. You can make an appointment by calling 646-888-5076.
Managing your feelings
After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.
The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.
Many people join one of MSK’s online or in-person bladder cancer support groups. For information about those groups and other resources, such as the Bladder Cancer Advocacy Network (BCAN), read the “Resources” section of this guide.
MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your healthcare team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.
If you don’t have a MyMSK account, you can visit my.mskcc.org, call 646-227-2593, or call your doctor’s office for an enrollment ID to sign up. You can also watch our video How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. For help, contact the MyMSK Help Desk by emailing firstname.lastname@example.org or calling 800-248-0593.Back to top
When to Call Your Healthcare Provider
Call your healthcare provider if you have:
- A fever of 101 °F (38.3 °C) or higher
- Any bleeding
- New leakage or drainage from your incision
- More leakage or drainage from your incision
- Pus-like drainage from your incision
- Redness at your incision
- Increased pain
- Nausea or vomiting
- Leg swelling or pain
- Shortness of breath
- Catheter or drainage tubes that are dislodged or not draining
- No bowel movements for more than 3 days
- No gas at all
- Decreased urine output
- Any problems you didn’t expect
- Any questions or concerns
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000. Ask to speak to the person on call for your healthcare provider.Back to top
This section contains a list of support services that may help you get ready for your surgery and recover safely.
Write down your questions and be sure to ask your healthcare provider.
MSK support services
Call if you have questions about your hospital admission, including requesting a private room.
Call if you have questions about anesthesia.
Blood Donor Room
Call for more information if you’re interested in donating blood or platelets.
Bobst International Center
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.
Food Pantry Program
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.
Integrative Medicine Service
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.
Patient and Caregiver Education
Visit the Patient and Caregiver Education website to search our virtual library. There, you can find written educational resources, videos, and online programs.
Patient and Caregiver Peer Support Program
You may find it comforting to speak with someone who has been through a treatment similar to yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.
Perioperative Nurse Liaison
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nursing Office
You may request private nurses or companions. Call for more information.
Resources for Life After Cancer (RLAC) Program
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program helps women who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, call 646-888-5076.
- Our Male Sexual and Reproductive Medicine Program helps men who are dealing with cancer-related sexual health challenges, including erectile dysfunction. For more information, or to make an appointment, call 646-888-6024.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.
Tobacco Treatment Program
If you want to quit smoking, MSK has specialists who can help. Call for more information.
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.
Bladder cancer support groups
Bladder Cancer Support Group
646-422-4628 or 646-888-8106
This is a live, in-person support and education group for people who have bladder cancer or who have been treated for bladder cancer. People share their personal experiences and provide practical and emotional support for one another. Discussions are led by a social worker, nurse, and WOC nurse.
This group meets the 2nd Thursday of each month from 12:00 to 1:30 pm. For more information, or to register, call the numbers above or email RLAC@mskcc.org.
Online Bladder Cancer Support Group
This is a live, online support and education group for people undergoing treatment for bladder cancer. People share their personal experiences and provide practical and emotional support for one another. Discussions are led by a social worker and a WOC nurse.
This group meets the 4th Thursday of each month from 4:00 to 5:00 pm. For more information, or to register, email email@example.com.
External support services
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
American Cancer Society (ACS)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
Cancer and Careers
A resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
Look Good Feel Better Program
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Advocate Foundation
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
Bladder Cancer Advocacy Network
National Association for Continence
United Ostomy Associations of America
Wound Ostomy Continence Organization
Go to this website to find a WOC nurse in your area. The website also has information on:
- All major suppliers of ostomy products
- Support groups
This section contains the educational resources that were referred to throughout this guide. These resources will help you get ready for your surgery and recover safely after surgery.
Write down your questions and be sure to ask your healthcare provider.
- Call! Don't Fall!
- Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
- Eating Well During Your Cancer Treatment
- General Exercise Program: Level 2
- Herbal Remedies and Cancer Treatment
- How to Use Your Incentive Spirometer
- Patient-Controlled Analgesia (PCA)
- What You Can Do to Avoid Falling