Dr. Sean Elliott, MD
Reconstructive Urologist
Bladder Augmentation Post-operative Instructions
Catheter
How many catheters? You should have 2 catheters when you go home from surgery. Both are Foley catheters. This means they have a balloon on the end of them to keep them anchored in the bladder. This balloon is inflated with water through the port on the outside of the catheter. When we remove the catheters, we will deflate the balloon using this port. Depending on the type of surgery you had, your 2 catheters may be coming out through different openings. If you have a Mitrofanoff then one catheter will be coming through that and the other catheter will either be in your urethra or coming through your abdominal wall (suprapubic tube). If you did not have a Mitrofanoff then one will be in your urethra and one coming through your abdominal wall (suprapubic tube).
Do I keep both catheters connected to a bag or can I plug them? Depending on the details of your surgery, we may have both catheters connected to two different bags at all times or we may have you cap (plug) one catheter and keep the other one connected to a bag. You should always have at least one catheter draining to a bag at all times.
Catheter Irrigation / Flushing
Irrigation of catheters. Your bladder augment makes mucous. This mucous can cause bladder infections, bladder stones and can plug the catheter. You will need to irrigate (flush) your bladder with water or saline once a day for the rest of your life to prevent this. In the first month after surgery, we use sterile saline to irrigate, but after the first month you can switch over to tap water. When someone is wearing a catheter all time (i.e., a Foley) their bladder augment makes even more mucous. So, for the first month after surgery, when you have the catheters in all the time, you will need to irrigate the bladder twice a day.
You should irrigate through both catheters every time, even if one of them has a plug in it and is not connected to a bag – it is important to keep that one from getting clogged too. When you irrigate it is important to clamp (plug) one catheter while you flush the other catheter.
Description of Technique of Irrigation click here
I have debris in my drainage tubing. It is normal to have strings of mucous or small clots (scabs) in the drainage tubing. Most of this gets flushed out during the irrigation process but some will flow out during the day.
What if one catheter isn’t draining? If you have 2 catheters hooked up to 2 bags and one drains more than the other, but both are draining then this is normal – one catheter is probably in a lower spot in your bladder and urine is preferentially going out that one due to gravity. But, if one catheter is not draining at all then it is very important that you get it draining again using catheter irrigation. Follow the steps described above to irrigate that catheter. If you cannot irrigate it, try irrigating the other catheter to get rid of as much mucous from the bladder as you can and then irrigate the clogged catheter again. If you still cannot irrigate it, it might just be stuck against the bladder wall; try moving it back and forth (in and out of the bladder) a few inches and irrigate as you do this. If you still cannot irrigate it, then it might be clogged with mucous, and you should call our clinic for further instructions. As long as one catheter is draining this is not an emergency and you can call during business hours. If neither catheter is draining, then this is an emergency; you should call our clinic line to speak with the doctor or nurse on call to receive further instructions.
I am bypassing urine around the outside of the catheter. This is unusual after a bladder augmentation surgery and is a sign that one of the catheters may be clogged and your bladder is too full. You should irrigate both catheters very soon to ensure that the bladder is draining well. If they do irrigate well, then the bypassing may be due to bladder spasms. Check your medicines to see if you are on a bladder spasm medicine. These can include oxybutynin (Ditropan), tolterodine (Detrol) or mirabegron (Myrbetriq). If you are not on one of these then you can call the clinic during business hours to request that we start one of these medicines.
Bowel Movements
Because we removed some intestine during the surgery, your bowel movements may be irregular for a few months. You may be constipated one day and have diarrhea the next. Narcotic pain medicines can cause constipation, so we send people home from the hospital with a stool softener (e.g., docusate or Colace). If your stools are too loose, then you can cut back on or stop the Colace. If your stools are still too loose, then you can take over-the-counter fiber supplements like Metamucil. If you are having loose stools, then it is important to drink lots of fluids because loose stools can dehydrate you. If loose stools persist for more than 3 days or if you have fever or abdominal pain, then this can be a sign of an infection and you should call our clinic.
Diet
By the time you leave the hospital, you should be back on your regular diet. But, because we removed some intestine during surgery, you may have a better appetite some days than others. The most important thing is that you stay hydrated. So, even if you don’t have much of an appetite, make sure that you drink at least 8 glasses of fluids a day.
Pain
When you leave the hospital, you tend to increase your activity level a bit at home compared to what you were doing in the hospital. As a result, your pain can increase for the first couple of days at home. Some pain along your incision is normal, especially with activity (twisting, or getting out of bed or a chair). You should be able to transition off the narcotic pain pills and onto just Tylenol and/or ibuprofen within a few days of going home. You might still need the occasional narcotic. You can take over-the-counter Tylenol 1000mg every 6 hours, not to exceed 4000mg a day. You can take ibuprofen with food 800mg every 8 hours, not to exceed 2400mg a day. It is okay to take both of these. If pain is intense and not controlled by this combination of medicines, or is deep inside your abdomen, then this could be a sign of a more significant problem, like an infection – please call our clinic to discuss.
Mobility
It is important to try to regain your baseline level of mobility. Being out of bed helps prevent pressure ulcers, pneumonia and blood clots in your legs. Some people who use a wheelchair worry that they might damage their incision or cause a hernia by using their upper body to transfer in and out of bed or the wheelchair. In fact, don’t worry about this; we would much rather have you up and out of bed than limiting your mobility to protect the incision.
Blood Thinners
Some surgeries people put at an increased risk of blood clots in the deep veins of the legs (deep venous thrombosis, a.k.a. DVT). Depending on your level of risk we may or may not have sent you home from surgery on a blood thinner to prevent DVT. This may be an injection or a pill and usually is only used for one month after surgery, if at all.
Symptoms of a DVT can include calf swelling and pain, especially if it is in one leg but not the other. A DVT can travel to the lungs resulting in a pulmonary embolus (blood clot in the veins of the lungs). Symptoms of a pulmonary embolus can include shortness of breath and chest pain. A pulmonary embolus can be life-threatening. If you have symptoms of a DVT or pulmonary embolus, whether or not you are on blood thinners, please call us immediately.
Restrictions
You should not drive or drink alcoholic beverages while you are taking narcotic medications (see below). You should not soak in a tub or pool until the catheter is removed. Daily showering is important.
Wound Care
The skin of your surgical incision may have been closed with staples or stitches (sutures). Once you are at home, your incision can be left open to air. You can get it wet in the shower. Let the water and soap run over it but don’t scrub it. If you are overweight, the incision can get moist under a fold of fat; it is good to try to keep this area dry with baby powder and/or a gauze pad or paper towel.
If your incision was closed with sutures, then those will dissolve over a month or so. If it was closed with stitches, then there are usually some small pieces of tape (SteriStrips) over the wound as well, to help take tension off the stitches. It is okay to get the SteriStrips wet in the shower. The SteriStrips will fall off in about 2-3 weeks. If individual strips are halfway off, then you can pull those off the rest of the way.
If your incision was closed with staples, then those should be removed about 2 weeks after surgery. You can make arrangements with our clinic or your primary care provider to have those removed.
Some pain in the incision is normal. Pain plus redness that is bigger than an inch (2.5 cm) or pain plus wound drainage, may represent an infection. Please call our clinic if you have any of these symptoms.
Medications
1. Vicodin/Norco – this is a narcotic pain medication which you should only need for about a week after leaving the hospital.
2. You can resume all of your outpatient medications that you were taking before surgery.
3. Bladder spasm medications – these are medications with names like oxybutynin (Ditropan) or mirabegron (Myrbetriq) or others. Now that you have a bladder augmentation you should not need these medications anymore.
Follow-up
Your follow-up appointment in Dr. Elliott’s clinic is generally 4 weeks after your surgery. This appointment may be with a Physician's Assistant, or with Dr. Elliott's fellow, rather than Dr. Elliott. They are part of his team and very experienced in the post-operative care of his patients. At this appointment we will remove your catheters and make sure you know how to do intermittent catheterization to empty your bladder.
Contact Us
University of Minnesota:
1. Nursing phone helpline at the Urology clinic (8A-5P M-F): 612-625-6401
2. Meghan Howe is Dr. Elliott's nurse in the Urology clinic. Her direct line is: 612-713-9649
3. If after hours, call the clinic line at 612-625-6401 and you will be connected with the Urology resident on call. If that fails, then call 612-273-3000 and ask to speak with the Urology resident on call.