Problems after bladder cancer surgery

There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

After surgery to remove your bladder, you need another way to collect and pass your urine. Doctors call this urinary diversion. There are different types of urinary diversion. Some of the possible problems depend on which type of urinary diversion you have.

General risks after an operation

After any major operation there is a risk of:

Infection

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Chest and breathing problems

Chest infections, including pneumonia, can be serious. 

You can lower your risk by:

• stopping smoking before your operation
• getting up and moving as soon as possible after your operation
• doing any breathing exercises your physiotherapist teaches you

If you get an infection you have antibiotics to treat it. 

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The risk of bleeding is greatest straight after your operation, and is much lower after 3 or 4 days. 

The treatment you need depends on what is causing the bleeding and how much blood you lose.

You might need a blood transfusion. Rarely, you might need to go back for urgent surgery. 

Problems after bladder cancer surgery

Your bowel not working

Your bowel might be slow to start working after surgery.  Doctors call this ileus. This can cause bloating, nausea and vomiting.

Treatment includes:

• stopping eating and drinking and having fluids through a drip
• a tube down your nose into your stomach (nasogastric tube) to drain bile and stop you feeling sick

This usually gets better with time.

Kidney problems

Bladder cancer surgery might affect how well your kidneys work. Your kidney function might get worse over time. This can happen for several reasons. For example, if your urine isn’t flowing as well as it should. Or if you have repeated urine infections.

Your doctors will do regular tests after your operation to see how well your kidneys are working. And to see if this changes.

Leaks

Leaks can happen where the surgeon joins the bowel back together. Or where they join the ureters to the ileal conduit or new bladder. This is called an anastomotic leak. This is a serious problem and you need to have treatment straight away.

Treatment depends on where the leak is. It might include:

• antibiotics
• draining the leak
• not eating or drinking

If the leak is urine, you will need:

• a tube through your skin to collect urine directly from your kidney (a nephrostomy tube)
• a tube that drains urine from your ureters (ureteric stent)

You will have endoscopies and scans to check that the area is healing. You might need more surgery to repair the leak if the other treatments don’t work.

You might need to stay in hospital longer if you have a leak.

Narrowing of the ureters

The tubes that drain urine from your kidneys (ureters) may become narrower over time. This can happen because of scarring. It is called a stricture.

If you develop a stricture, your doctor can stretch the ureter slightly. They call this dilatation and it opens up the ureter again. They might also put in a thin tube (ureteric stent) to keep the ureter open.

You might need to have this repeated if the narrowing happens again. Some people might need to have surgery to repair the stricture.

Problems with nutrients and metabolites

Your surgeon removes part of your bowel (ileum) to make either a new bladder or an ileal conduit. The ileum absorbs vitamin B12. So, you might have a shortage (deficiency) of vitamin B12, folate and vitamin D after surgery if they have removed a large part of your ileum.  Your doctor will monitor your vitamin B12, folate and vitamin D levels.

You will have blood tests to monitor the levels of waste products (metabolites) in your blood. The wall of your new bladder or ileal conduit is made of bowel. When it is holding urine, this bowel wall can reabsorb some of the waste metabolites in the urine.

Hernia

With any surgery to your tummy (abdomen), there is a small risk of a hernia forming at the surgical site.

Your surgeon will advise you to avoid activities or exercises that put strain on the abdominal wall. This will be for a period of time after surgery. It includes activities such as lifting boxes, hoovering and certain gym exercises.

If your job involves heavy lifting, you should discuss this with your occupational health advisor at work.

If you have a urostomy, there is a risk of a hernia around the stoma. You should avoid regular heavy lifting. There are stoma appliances that can support the stoma and reduce complications caused by the hernia.

Life after bladder cancer surgery

Your sex life and fertility

This operation might affect your sex life. 

Women

For some women, the surgery might shorten your vagina or make it narrower. Sensations during sex may feel different. Your surgeon might also remove your womb during surgery. This means you can’t have children.

Talk to your specialist nurse or surgeon about this before your surgery. They can offer you some support. They might also tell you about things you can do to help with some of these changes. 

Men

Your surgeon also removes your prostate gland when they remove the bladder. This means you will not be able to ejaculate. So your orgasms will be dry. This operation can also damage the nerves that control your erections. So you may not be able to get an erection anymore.

After your surgeon removes your prostate gland, you can no longer father a child.

Talk to your surgeon or nurse specialist about this before surgery. They can offer you support. They might also tell you about what you can do to help with any changes to your sex life.

Leaking urine (incontinence) after bladder reconstruction

Some people leak urine after a bladder reconstruction, particularly at night.

Your surgeon and specialist nurse will talk to you about how common this is. They will tell you whether it is likely to be a problem for you.

They can advise you what to do about it if it happens. And what might help. For example, they might tell you how to do regular pelvic floor exercises to strengthen your pelvic floor. 

Lymphoedema

Lymphoedema is a build up of lymph fluid that causes swelling in a part of the body. It can develop if there are problems with the lymphatic system.

As part of your surgery your surgeon usually have some of the lymph nodes around your bladder. This means you are at risk of lymphoedema in your legs. This is because surgery can damage the lymph pathways and block the normal drainage of lymph fluid.

You might need to wear supportive garments. Your surgeon or specialist nurse will refer you for this.

Change to your bowels

Bladder cancer surgery can cause bowel changes. This is because the surgeon removes part of your bowel and it is now shorter. You may notice that:

• your poo is looser than normal
• you go to the toilet more frequently
• you get constipated and need medicine to help you go

It can take some time to return to normal, often a few months or longer.