Dr. Anup Ramani is one of the best Uro oncologist, Surgeon in Mumbai, India providing Robotic Surgery and Treatment for Prostate Cancer, Kidney Tumor Surgery/Stone Removal, Urinary Bladder Cancer and Adrenal Gland Treatment, Enlarged Prostate Surgery and treatment, Penis Cancer/Partial Penectomy/Robotic Pyeloplasty Surgery and Treatment.
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Preventing Infections After Urinary Bladder Cancer Surgery: Hygiene and Warning Signs

26 Dec
By Dr. Anup Ramani
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Navigating Recovery: A Guide to Infection Prevention and Care

Recovering from major medical procedures requires a comprehensive approach to health, focusing not just on the healing of incisions but on the long-term adaptation of the body’s functions. For patients navigating life after significant urological procedures, the primary goal is to establish a routine that prioritizes hygiene, recognizes early warning signs of complications and fosters a smooth transition back to daily life. This guide aims to provide an in-depth exploration of post-operative care, specifically focusing on infection prevention, hygiene protocols for urinary diversions and the critical signs that warrant immediate medical attention, ensuring patients feel empowered and informed during their recovery journey.

Urinary Bladder Cancer: The Post-Surgical Landscape

When a patient undergoes treatment for invasive conditions, the removal of the bladder is often a necessary step to halt the progression of the disease. This significant change alters how the body stores and eliminates urine, requiring the creation of a new path, known as a urinary diversion. Whether the surgeon creates an ileal conduit (urostomy), a neobladder or a continent cutaneous diversion, the anatomy is fundamentally changed.

The introduction of bowel segments into the urinary tract creates a unique environment. Unlike the natural bladder, which is lined with urothelium designed to handle urine, the intestine naturally produces mucus and contains different bacterial flora. This interaction between the urinary system and the digestive tissue increases the susceptibility to infections. Therefore, understanding the nuances of urinary bladder cancer recovery involves more than just waiting for scars to heal; it requires active participation in maintaining the sterility and function of the new urinary system. The transition period is critical, as the body learns to adapt to its new plumbing and the immune system recovers from the stress of surgery.

Robotic Radical Cystectomy and Infection Risks

Modern advancements have introduced minimal invasive techniques to reduce recovery time and surgical trauma. Robotic radical cystectomy has become a prominent approach, utilizing robotic arms to perform precise movements through small incisions. While this method generally lowers the risk of external wound infections compared to traditional open surgery due to smaller exposure to the air and less tissue manipulation, the internal risks remain significant.

The internal reconstruction involves the same complex rearrangement of the ureters and intestines. Consequently, even with the advanced nature of robotic cystectomy, the risk of urinary tract infections (UTIs) remains a primary concern. The catheterization required during the initial healing phase can introduce bacteria if not managed with strict aseptic techniques. Furthermore, the reduced mobility often associated with recovery, even if shorter with robotic methods, can lead to urinary stasis – where urine sits too long in the new reservoir – creating a breeding ground for bacteria.

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Bladder Removal Surgery: Care for Urinary Diversions

The cornerstone of preventing infection after bladder removal surgery lies in the meticulous care of the urinary diversion. The specific hygiene routine depends heavily on the type of diversion created, but the principles of cleanliness remain universal.

For Patients with an Ileal Conduit (Urostomy):

The stoma, the opening on the abdomen where urine exits, requires daily attention. The skin around the stoma (peristomal skin) must remain intact and healthy. Urine is acidic and can cause skin breakdown if it leaks under the wafer (the adhesive barrier). Broken skin is a direct portal for bacteria to enter the soft tissues of the abdominal wall.

  • Pouch Changing Routine: It is vital to change the pouching system regularly, not just when it leaks. Cleaning the stoma should be done with warm water; harsh soaps or alcohol can dry out the skin and cause cracks.
  • Emptying the Bag: A full bag creates back-pressure. If the urine cannot flow freely out of the stoma because the bag is full, it may pool around the stoma site or back up into the kidneys. To prevent this, the bag should be emptied when it is one-third to one-half full.
  • Night Drainage: Using a larger night drainage bag prevents the need to wake up constantly and keeps the system flowing downhill, which is crucial since the anti-reflux mechanism of the natural bladder is gone.

For Patients with a Neobladder:

A neobladder allows for more natural urination but comes with a higher maintenance load regarding mucus management. Since the new bladder is made of intestine, it will secrete mucus forever.

  • Irrigation: If mucus accumulates, it can block the urethra or the catheters, leading to urinary retention and infection. Regular irrigation with sterile saline is often required, especially in the first few months, to wash out mucus plugs.
  • Timed Voiding: Unlike a natural bladder, a neobladder does not have nerves to signal “fullness” in the same way. Patients must stick to a strict schedule to empty the bladder. Over-distension can stretch the pouch and make it floppy, preventing complete emptying and leaving residual urine where bacteria can multiply.

Urinary Bladder Cancer Treatment: The Role of Hygiene

Beyond the specific care of the stoma or neobladder, general hygiene plays a pivotal role in the broader context of urinary bladder cancer treatment recovery. The immune system is often taxed from the cancer itself and the surgical intervention, making the body less efficient at fighting off common pathogens.

Hand Hygiene: This is the single most effective way to prevent infection. Before handling any part of the urinary system – whether it is changing a urostomy bag, self-catheterizing or connecting a night bag – hands must be washed thoroughly with soap and water for at least twenty seconds. Hand sanitizers are a good backup, but they do not replace scrubbing when handling catheters.

Equipment Sterility: For those who self-catheterize to empty a continent diversion or a neobladder, the catheters must be kept clean. Single-use catheters are the gold standard to reduce infection risk. If reusable catheters are employed, they must be cleaned and stored exactly according to the medical team’s instructions. Storage containers should be breathable to prevent moisture buildup, which encourages bacterial growth.

Hydration as a cleanser: Drinking adequate fluids is a form of internal hygiene. A high fluid intake helps flush the kidneys and the new bladder reservoir, diluting the urine and washing away bacteria before they can adhere to the lining of the urinary tract. Water is the best fluid for this; sugary drinks can sometimes feed bacteria and excessive caffeine might irritate the new system.

Warning Signs of Infection

Recognizing the early signs of an infection can mean the difference between a simple course of oral antibiotics and a hospital readmission for sepsis. Because the anatomy has changed, the symptoms might not present exactly like a typical bladder infection.

Fever and Chills: A rise in body temperature is often the first systemic sign that the body is fighting an invader. Shaking chills (rigors) usually indicate that bacteria have entered the bloodstream, requiring immediate medical evaluation.

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Changes in Urine:

  • Smell: While some odor is normal due to the intestinal tissue, a foul, strong or “fishy” smell that persists despite good hydration is a warning sign.
  • Color and Clarity: Cloudy urine is common due to mucus, but if it becomes thick, opaque or changes color drastically, it warrants a check-up.
  • Hematuria: While slight spotting can happen, significant blood in the urine appearing suddenly is a red flag.

Flank Pain: Pain in the lower back, specifically on the sides just below the ribs, suggests the infection may have ascended to the kidneys. This is serious because the kidneys are more vulnerable after the ureters have been re-implanted.

Stoma or Wound Changes:

  • Redness: Spreading redness around the incision or the stoma site can indicate cellulitis (skin infection).
  • Discharge: Pus or thick, yellow/green fluid oozing from the incision is not normal.
  • Separation: If the wound edges appear to be pulling apart, this increases the risk of deep infection.

Digestive Symptoms: Nausea and vomiting can be signs of a urinary infection in this population. Because the bowel and urinary tract are now closely linked, an infection in the urinary system can cause the bowel to slow down (ileus), leading to nausea.

Bladder Cancer Treatment and Lifestyle Adjustments

Recovery is not just about avoiding bacteria; it is about building a lifestyle that supports the body’s defenses. Bladder cancer treatment often involves a multidisciplinary approach, including nutrition and physical therapy.

Nutrition and Immunity: A diet rich in proteins is essential for wound healing. The body uses protein to repair the tissues cut during surgery. Furthermore, vitamins A and C, along with Zinc, play roles in skin health and immune function. Constipation should be aggressively managed with high-fiber foods and stool softeners because a full bowel can press against the urinary diversions, impeding flow and increasing infection risk.

Physical Activity: Early mobilization is encouraged to prevent pneumonia and deep vein thrombosis, but it also helps with digestion and urinary drainage. Walking promotes blood flow, which delivers immune cells to the surgical sites. However, strenuous activity should be avoided until cleared by the surgeon to prevent hernias, particularly around stoma sites.

Clothing and Comfort: Wearing tight clothing around the waist can restrict the flow of urine into a pouch or put pressure on a healing incision. Loose, comfortable clothing promotes better circulation and reduces moisture buildup in skin folds, which can otherwise lead to fungal infections.

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Cost of Bladder Cancer Surgery and Long-Term Care

When discussing the journey of recovery, one cannot entirely overlook the economic aspect. The cost of bladder cancer surgery extends beyond the initial hospitalization. It encompasses the long-term need for supplies, catheters, night bags and potential readmissions for complications like infections.

Preventing infections is also a financial strategy. Treating a severe urinary tract infection or a wound complication often involves expensive antibiotics, specialized nursing care and potentially additional procedures. By investing time and effort into rigorous hygiene and preventive care, patients not only protect their health but also mitigate the financial burden associated with post-operative complications.

Conclusion

Recovering from surgery for urinary bladder cancer is a profound adjustment that demands patience, vigilance and a proactive attitude toward hygiene. The creation of a urinary diversion, whether through a robotic radical cystectomy or open surgery, changes the landscape of the body’s waste elimination. By mastering the daily routines of stoma or neobladder care, maintaining strict hand hygiene, staying hydrated and acutely observing the body for warning signs, patients can significantly reduce the risk of infection. This diligence allows the focus to shift from merely healing to truly living, empowering survivors to reclaim their quality of life with confidence and security.

Frequently Asked Questions

You should empty your urostomy bag when it is one-third to one-half full to prevent urine from backing up into the stoma and kidneys, which can cause infection.

Yes, because the neobladder is made from a piece of intestine, it will naturally produce mucus, which may need to be flushed out to prevent blockages.

You can generally shower once the doctor gives approval, but you should avoid scrubbing the stoma or incision directly; let soapy water run over it and pat dry gently.

Common signs include high fever, chills, nausea, vomiting and pain in the back or flank area (sides of the lower back).

Drinking plenty of water helps dilute the urine and flushes bacteria out of the urinary tract and diversion system, making it harder for infections to take hold.

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Dr. Anup Ramani is one of the best Uro oncologist, Surgeon in Mumbai, India providing Robotic Surgery and Treatment for Prostate Cancer, Kidney Tumor Surgery/Stone Removal, Urinary Bladder Cancer and Adrenal Gland Treatment, Enlarged Prostate Surgery and treatment, Penis Cancer/Partial Penectomy/Robotic Pyeloplasty Surgery and Treatment.

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PARTIAL PENECTOMY
  • Partial penectomy is done in cases where glans and distal penis is involved with carcinoma. 
  • Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
  • Patients who develop stones in the kidney or ureter, often experience severe pain.
  • This condition usually needs a procedure to remove the kidney stones.
  • This procedure is called ureteroscopy and is performed very commonly.
  • It does not require any cuts and hence it is painless.
  • The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
  • The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
  • The procedure takes about 40-50 minutes. 
  • A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
  • Patient is mobile and walking in the room the same evening.
  • Hospital stay is one night and patient is discharged the next day after removal of the catheter.
  • Patient has to come back after six weeks to remove the stent in the kidney.
  • Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
  • We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
  • Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
  • This procedure is called TURP and is performed very commonly.
  • It does not require any cuts and hence it is painless.
  • The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
  • The overgrown prostate is dissolved with a laser bloodlessly.
  • The procedure takes about 40 minutes.
  • A catheter (urine pipe) is kept after the procedure to drain the bladder.
  • Patient is mobile and walking in the room the same evening.
  • Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
  • Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
  • We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR

  • Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.

  • Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.

  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).

  • Dr. Ramani then sits in the controlling console to perform the surgery.

  • On an average, a robotic adrenalectomy takes one hour.

  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.

  • A urine catheter and bag to drain the bladder is inserted during surgery.

  • A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.

  • Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.

  • The drain pipe, if kept, is removed in the room on day 2 after surgery.

  • The catheter is removed on day two after surgery.

  • Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).

  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.

RETURN TO ACTIVITY

  • On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.

  • Heavy activities like running, weight lifting can be resumed after a month

FOLLOW UP AFTER SURGERY

  • Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
    Local patients usually meet Dr. Ramani after two weeks to discuss report.

  • Outstation patients are counselled on a phone consultation.

ROBOTIC SURGERY FOR BLADDER CANCER
  • Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
  • Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
  • Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
  • Dr. Ramani then sits in the controlling console to perform the surgery.
  • On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
  • A urine catheter and bag to drain the new bladder is inserted during surgery.
  • Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
  • Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
  • The drain pipes are removed in the room on day 3-5 after surgery.
  • Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
  • On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
  • Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY

  • Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.

  • Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.

  • Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.

  • If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.

ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
  • Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
  • relatively easier but still requires significant experience to consistently deliver results.
  • Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
  • Dr. Ramani then sits in the controlling console to perform the surgery.
  • On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
  • A urine catheter and bag to drain the bladder is inserted during surgery.
  • A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
  • Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
  • The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
  • Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
  • On the day of discharge, patient is totally self- sufficient. 
  • They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. 
  • Almost all patients are back to work within 2-3 weeks of surgery.
  • Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
  • Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
  • Local patients usually meet Dr. Ramani after two weeks to discuss report. 
  • Outstation patients are counselled on a phone consultation.