Postoperative Instructions for Cystoscopy and Transurethral Bladder Tumor Resection (TURBT)

Bladder chemotherapy

You may have a chemotherapy agent placed in the bladder at the end of surgery. This stays in the bladder for one hour after surgery. This can help decrease the risk of recurrence of bladder cancer. If chemotherapy is placed, you will have a tube draining the bladder called a Foley catheter. A Foley catheter is a tube that carries urine from your bladder, to the outside of your body, into a bag. The medication will be drained from the bladder using this catheter in the recovery room.

Foley catheter

A foley catheter may be left place for 3 to 14 days to allow the bladder time to heal. Keep the catheter well secured to the leg. Avoid any tugging on the catheter. It is important to make sure the catheter drains well. The bag should always be lower than your bladder. During the day the catheter can be placed to a leg bag you can wear under your clothes. Place the catheter to a large back at night so you don't have to get up at night to drain the bag. You will receive instructions for catheter care before discharge from the hospital.

While the catheter is in place you may have leakage of urine or blood tinged urine around the catheter. This may be a result of bladder spasm. This may be more noticeable at the time of bowel movement. You may notice blood, debris, clot or mucous sediment in the drainage tube for catheter bag. The color of the urine may vary.

Bladder symptoms

It is normal to blood, debris and small blood clots in the urine for one to two weeks after surgery. If you see blood in the urine, drink more water and be sure avoid strenuous activity or heavy lifting. You may feel burning and stinging with urination for the first several weeks after surgery. You may have more frequent urination and a greater sense of the urge to urinate.

Cystogram

Your surgeon may order a bladder x-ray called a cystogram. This is to check the bladder has healed completely and that there is no leak from the bladder. The cystogram determines if it is safe to remove the catheter. The office will arrange an appointment for a cystogram in the radiology department. You will come to our office immediately after the cystogram. The radiologist will call our nurse to let them know the cystogram is normal. Our nurse will remove the catheter if the cystogram is normal. If the cystogram shows a leak, the catheter is left in place. Often the cystogram is repeated after giving the bladder another week to heal.

Medication

The recovery room nurse will review when to restart your regular medications. Please be sure you understand and when to restart your regular medications before discharge from the hospital.

Pain management

You can obtain good pain relief by taking acetaminophen (Tylenol) every four hours while awake for the first several days. You may receive a prescription for pain pills. You can use these prescription pain pills in addition to acetaminophen every four hours. Do not exceed 3000 mg acetaminophen per day. Avoid acetaminophen if you have poor liver function.

You may also place a heating pad over the bladder to ease postop discomfort. Avoid aspirin or ibuprofen compounds, such as Advil, Nuprin, Motrin, Bufferin, etc. until the blood in the urine has cleared for several days.

Azo (Urinary Pain Relief, Pyridium, phenzaopyridine) are over-the-counter pills that help relieve bladder pain. Take as directed. This turns urine and body fluids orange.

Oxytrol patch (oxybutynin) is an over-the-counter patch. This helps ease frequent urination and bladder spasm. Take as directed. This can be used in women and men. Side effects can include dry eyes, dry mouth, constipation and confusion in the elderly. Do not take if you have glaucoma. Do not use for 24 hours prior to catheter removal because it can make it more difficult for you to empty the bladder.

Avoid constipation

Take a stool softener by mouth twice a day to avoid constipation. Constipation can cause you to strain to have a bowel movement, which puts stress on the surgery site and can cause bleeding and poor healing. A stool softener or laxative may be prescribed or is available at any drug store without a prescription (Senna or Senokot or SennaGen, Dulcolax or Bisacodyl, Milk of Magnesia or magnesium hydroxide). Decrease or hold the stool softener if you have loose stool or diarrhea.

Diet

After anesthesia, begin with clear liquids. Avoid any heavy meals on the day of the procedure. You may slowly resume your normal diet. Drink plenty of water. The more blood you see in the urine, the more water you should drink to flush the system and keep clots from forming. Eat a high fiber diet, with plenty of vegetables, to avoid constipation.

Activity

Avoid strenuous activity or lifting more than ten pounds until the blood in the urine has cleared for several days. This may take 1-2 weeks. Then slowly resume your normal activity.

Bathing

You may shower after surgery. You may shower if you have a catheter. Avoid bathing in a tub or submerging in water while the catheter is in place.

Postoperative plan

Call the office to make an appointment in 7 to 10 days if you do not already have a postop appointment. Call the office for fever over 101°F, nausea and vomiting, if the catheter stops draining or you are unable to urinate for more than four hours.

Pathology results

Pathology results are typically available in two to fourteen days. Pathology results can take longer if special staining is done or second opinion is obtained. Pathology results are available electronically on the patient portal from the hospital or our office. Pathology results are available as soon as they are read by the pathologist. Use our website or other well known websites to understand more about bladder cancer. Make sure you have an appointment with your surgeon to review the pathology report and make a plan for management.