1. Urinate regularly Because the new bladder does not have the sensory function of the original bladder, you need to develop the habit of urinating regularly. Remember, not urinating for a long time is the cause of serious complications after in situ neobladder surgery. As the postoperative time increases, the capacity of the new bladder will gradually increase and you can urinate once every 2 hours during the day and you should set an alarm for once every 3 hours at night. If the blood gas analysis results show that the organism is well compensated, the voiding interval can be gradually extended, for example by 1 hour at a time, gradually rising from 2 hours to 3-4 hours. Patients must exercise to prolong the voiding interval thus gradually increasing the bladder volume to an ideal volume of about 400-500 ml, which should be maintained even if incontinence occurs. The increased volume of the bladder can significantly improve the patient’s ability to control urine. However, the bladder volume should not be allowed to exceed 500 ml. In case of metabolic problems, the duration of urination needs to be shortened to reduce the absorption of toxins in the urine by the new bladder and to reduce the risk of infection.
2. Urination posture Patients can urinate in squatting or sitting position in the early stage of self urination, and if urination is clear, standing urination can be tried. Relax the pelvic floor muscles during urination, and then slightly increase the abdominal pressure. Urination can be assisted by hand pressure on the lower abdomen and bending forward. Either method requires emptying of the bladder and therefore monitoring of the residual urine volume. Squatting and seated voiding are recommended based on the experience of previous patients. It is important to ask patients with a new bladder to remember to relax the pelvic floor muscles before increasing the abdominal pressure to urinate during voiding.
3. Drink 2000-3000 ml of water per day The salt loss syndrome caused by neobladder can cause hypovolemia, dehydration and weight loss if it is severe. Therefore it is important to ensure 2000-3000 fluid intake per day after surgery (including drinking water, beverages, soup and other liquid diets) and also to increase the salt intake in the patient’s diet. Frequent weight monitoring is recommended.
4. Flocculation in the urine The intestine secretes mucus, so there will be a certain amount of flocculation in the urine of patients after neobladder surgery that is not a urinary tract infection. Usually the amount of mucus secreted by the intestinal mucosa of the neobladder will gradually decrease over time and rarely causes urinary tract obstruction. However, if there is urinary tract infection and bacteriuria need to be actively dealt with.
5.Regular review Post-operative review of the new bladder can provide proper guidance to patients and early detection of adverse reactions, which is the key to ensure bladder function and avoid serious complications.
Patients with neobladder are at risk of developing metabolic acidosis after surgery, which may manifest as drowsiness, fatigue, nausea, vomiting, anorexia and burning sensation in the abdomen if present. Monitoring alkaline residuals by venous blood gas analysis can provide insight into acidosis. Some patients require a period of treatment with sodium bicarbonate (2C6 g/day) for correction.
Postoperative tests are also required on a regular basis. For example: (1) ultrasonography: to monitor residual urine volume and renal morphology; (2) cystourethrography and refluxography: to understand the morphology and volume of the new bladder, the presence of urethral strictures, and the presence of ureteral reflux; (3) intravenous urography: for the presence of hydronephrosis; (4) urodynamics: to understand the pressure, volume, and compliance of the new bladder; (5) cystourethroscopy: to understand the presence of recurrent urethral tumors.
If there are symptoms such as thin urine line, difficulty in urination, lower abdominal bulge, back pain, fever, etc., it is necessary to consult the doctor promptly. The doctor will take treatment measures according to the specific situation, and delay in diagnosis and treatment may lead to serious consequences.