How to care before and after bladder cancer surgery

The treatment of bladder cancer is a comprehensive treatment with surgery as the main treatment. In principle, single, superficial, and small tumors can be treated with bladder-preserving surgery; large, multiple, recurrent, and triangular tumors should be treated with radical cystectomy. For all bladder-preserving surgical treatments, intravesical drug instillation is required after surgery to prevent or delay tumor recurrence.

Preoperative care

(1) Psychological care

(2) Observe and record the degree of hematuria and the presence or absence of bladder irritation signs.

(3) Advise the patient to eat high-protein, easily digestible, nutritious foods to correct anemia and improve overall condition; drink plenty of water to avoid blood clots blocking the urinary tract.

(4) For patients who undergo radical cystectomy and bladder replacement surgery, bowel preparation should be performed according to the same procedures as for colorectal surgery. Female patients should begin vaginal flushing 3 days before surgery, 1 to 2 times a day.

Postoperative Care

(1) Observe vital signs: After radical bladder cancer resection, due to the large surgical wound, there may be a lot of bleeding. Therefore, vital signs should be closely observed to ensure smooth blood transfusion and infusion. Symptoms and signs of shock should be discovered early, and treatment and care should be provided in a timely manner.

(2) After bladder tumor transurethral resection, routine flushing should be performed for 1 to 3 days. The color of the bladder flushing drainage fluid should be closely observed. According to the change of the drainage fluid color, the flushing speed should be adjusted in time to prevent blood clots from blocking the urinary catheter, ensure that the urinary catheter is unobstructed, and prevent the balloon from rupturing. After stopping bladder flushing, the patient should be instructed to drink more water to play the role of internal flushing.

(3) Patients can eat 6 hours after transurethral resection of bladder tumors. The diet should be nutritious and high in crude fiber. Spicy and irritating foods should be avoided to prevent constipation.

(4) Nursing for radical cystectomy and ileal bladder replacement: ① Continue gastrointestinal decompression after surgery, closely observe the amount, nature, and color of gastric juice, and keep records. After gastrointestinal function is restored, remove the gastric tube, start taking sugar water, and gradually transition to liquid, semi-liquid, and normal food. ② Closely observe the size, shape, and color of the stoma, and keep the wound and stoma dressing clean and dry. The size of the stoma can be measured on the 7th day after surgery, but it will continue to shrink within 6 to 8 weeks. Disinfect the skin around the ileal stoma once a day and apply zinc oxide ointment to protect the skin. ③ Closely observe and record the urine drained by the left and right ureteral stents and ileal bladder replacement drainage tubes to understand the function of both kidneys and ileal bladder replacement. ④ Replace the stoma urine bag in time and fix the urine bag to the thigh when the patient gets up and moves.

(5) Prevention of infection: Measure body temperature and changes in white blood cells regularly to observe whether infection occurs. Keep the skin around the stoma clean and dry, turn over, tap the back, and cough up sputum regularly. If the sputum is thick, use atomization inhalation. Appropriate activities and other measures can prevent infection.

(6) Care of drainage tubes: Various drainage tubes should be labeled to record drainage conditions and keep drainage unobstructed. Ureteral and ileal bladder drainage tubes should be removed 10 to 12 days after ileal cystoscopic surgery and replaced with a skin ostomy bag; pelvic ureteral drainage tubes should be removed 8 to 10 days after controllable bladder surgery, urinary tract drainage tubes should be removed 12 to 14 days after surgery, and output tract drainage tubes should be removed 2 to 3 weeks after surgery, and the patient should be trained to urinate on his own.