It takes time to get used to the changes in your body when you've had reconstructive surgery. Depending on the type of surgery you had, you may not urinate the way you used to. You may have an abdominal opening and an external urine bag to cope with. You'll want to talk with your health care team about any questions and concerns you may have.
After having any type of urostomy, you'll have a drainage tube from the new bladder coming out through an opening (stoma) in the abdomen. This may be in place for 2 to 3 weeks after surgery. Your surgeon may take X-rays to check how well your bladder has healed and to ensure there isn't leakage before removing the drainage tube.
After the operation, urine will constantly flow through your ureters into the external pouch. Once the tube is removed, you'll use an adhesive patch to hold a plastic pouch to your skin over the stoma. You will need to change the pouch every 3 to 5 days. When the pouch is full, simply empty the urine through a valve at the bottom of the appliance. When you change the appliance, wash the abdominal area around the opening thoroughly with soap and warm water. Then attach a new pouch. A specially trained nurse, called an enterostomal nurse, will help supervise your care when you've had a urostomy. The nurse will give you instructions on keeping the urine bag, catheter, or abdominal opening clean. The nurse will also give you advice on lifestyle issues, such as having sex or cleaning your urine bag at work.
When you come home after the surgery, watch out for these possible warning signs that there may be problems with your urostomy:
Redness or swelling around the abdominal opening
Urine leaks from the bag or catheter
A blockage of urine flow
Call your doctor or stoma nurse immediately if you notice any of these problems.
After the operation, urine will flow through the ureters into the pouch in your body. The pouch will hold more urine as time goes by. It will hold about a pint of urine a few months after the operation.
You will learn to recognize the sensation when the pouch is getting full of urine. When it's full, you will pass a tube, called a catheter, into the opening in your abdomen to let the urine out. For a few weeks after the surgery, you'll probably need to drain the pouch every few hours. As the pouch stretches, you will probably empty it every 4 to 6 hours.
You will be shown how to drain it. First, wash your hands thoroughly. Take the disposable catheter out of the package. Put a little gel on the tip. Gently push the catheter into the abdominal opening until urine starts to come out. Drain the urine into a container, then flush the urine down the toilet. The catheter is reusable but needs to be washed with soap and water. Wash your hands following this procedure.
The ability to control urination during the day is better than 90% with a neobladder. Your ability to control urine flow at night may not be quite as good, particularly in the first 6 to 9 months after surgery. You may be able to manage the problem by drinking less before bedtime. Men may also want to talk with their doctors about a condom catheter, which attaches to the penis like a condom and collects urine.
The physical and emotional changes from your cancer surgery may be significant. Be certain to ask your medical team for follow-up resources that will help you and your family manage not only the physical effects of the cancer treatment, but also the mental and emotional changes.