Dr James Thompson is an experienced robotic, laparoscopic, endoscopic and open urological surgeon. He has sub-specialty training in (and passion for) the treatment of prostate, bladder and kidney cancer using the latest robotic surgery techniques and for high-impact cancer research that has the ability to immediately improve quality of life and cancer cure rates for the community.
Post operative care following Bladder Surgery
DAY OF ADMISSION
Immediately on waking, take your second high-calorie clear fluid drink. You must take it at least 2 hours before your surgery, so if the surgery is due to start at 730am, you must take the drink at 430-5am and NOT after 730am or it could delay your surgical start time, because the anaesthetist can’t put you to sleep until it has cleared from your stomach, which takes 2 hours.
You will arrive at the hospital at your designated time, usually very early in the morning around 6-630am, then undergo an admission process with admin staff and a nurse then be dressed for surgery.
Once you are in a bed and wheeled around to the operating theatre, our anaesthetist (who will have already called you for a phone pre-op assessment) will be waiting to meet and assess you in person, in the pre-op anaesthetic bay. Once they have spoken with you, they will give a gentle sedative which will remove your anxiety and make you feel very relaxed, as its common and normal to feel anxious just prior to surgery.
THE OPERATION
The anaesthetist will gently insert an IV cannula into your arm and then may recommend a spinal anaesthetic, which involves a tiny needle into the lower spine. This is commonly helpful in robotic bladder surgery but not essential, so can be avoided if you have spine problems or do not wish it to be done.
Once you’re asleep, we make 6 tiny keyhole incisions in your abdomen and set up for the robotic surgery. Robotic bladder surgery takes 5 hours on average in men and 5 ½ hours in women, i.e. 2 hours to remove the bladder and pelvic organs (prostate in men/ uterus, cervix, ovaries, urethra and front wall of vagina in women), 1 hour to remove the pelvic lymph nodes, and 2 hours to create the new urinary reservoir/ ileal conduit (i.e. isolate a short segment of intestine and join the ureter tubes to it); the initial setup and keyhole access takes 30 minutes, and the final removal of specimens, closing the keyholes and creating your new stoma takes another 45mins. So the entire surgery takes on average 7 hours, plus time for the anaesthetic at the start and end.
AFTER THE OPERATION
You will be transferred to the high dependency unit (HDU/ ICU) after 2 hours in the recovery room, with a urine bag over your stoma, an abdominal drain tube, oxygen nasal prongs on your face and intravenous fluid therapy in your arm. You can have some sips of fluid and ice and sit up in bed.
The next day, you will usually be transferred to the surgical ward
You will sit in a chair, do deep breathing and leg exercises and have short walks
You can drink fluids, start tablet medications and stop your IV fluids, then you will progress to a full diet once passing wind (flatus)
Routine blood tests will be performed on most days whilst in hospital
You will do daily practice to learn how to manage your stoma bag independently
You will receive daily injections of clexane to prevent clots and learn how to self-inject
LENGTH OF STAY
Your hospital stay is between 5-10 days, on average 7 days.
You will be allowed to go home once you are eating, opening your bowels, walking well and able to look after your own stoma bag.
At this point we like to get you home (rather than remain in hospital) because you are able to sleep better, eat better, walk around more and recuperate more comfortably, plus have a lower chance of infections and blood clots.
PAIN CONTROL
We will make sure your pain is very well controlled.
You will be given a slow release oral pain tablet (eg Palexia), IV Panadol, an anti-inflammatory medication and short acting powerful pain reliever (morphine/ endone), if needed.
Please inform the nurses if your pain is not controlled, it is important to communicate to them your level of pain so we can ensure it is relieved in a timely fashion or if severe that a doctor assesses your promptly.
Pain relief requirements are very individual. Some patients require very little analgesia, others require more; whatever the case you will be sent home with suitable analgesia tailored for your individual needs, to take as required.
WHEN YOU GO HOME
When you leave hospital, we will provide you with the following:
· Stoma supplies e.g. stoma bags, night bags
· Medications for pain relief e.g. palexia, paracetamol
· Laxatives to prevent constipation
· Clexane injections and TED stockings to prevent blood clots
INSTRUCTIONS CLEXANE INJECTIONS AT HOME
If you have extensive lymph node removal, then in order to prevent a blood clot (DVT) you will be discharged with a 2-3 week supply of once-daily Clexane injections (usually 40mg, but 20-60mg depending on your weight and kidney function). You need to self-inject just under the skin into either the abdomen (in the region above the level of the belly button and below the ribs) or the outside of th upper arms (less preferable as less fat here and difficult to self-inject).
You should NOT inject into the abdomen below the belly button or the thighs, because fluid from this area does not reliably drain into the blood stream after pelvic lymph node removal, so if injected here it may not be effective in preventing clots.
FOLLOW-UP APPOINTMENTS AFTER DISCHARGE FROM HOSPITAL
Dr Thompson will arrange for removal of your ureteric stents at 3-4 weeks; if the tips of the blue stents are protruding out the stoma by then, they can simply be pulled out. If they are not protruding, Dr Thompson will pass a small fibre-optic flexible camera into the stoma (under local anaesthetic) and remove them. This is most easily done in an operating theatre because we have the appropriate equipment there but is very minor and only takes a few minutes. We will arrange a urine test prior (to check for infection).
Dr Thompson will see you in the office for a check-up at 6-weeks postop with a blood test, then will arrange a follow-up CT scan at 3 months.
Your stoma nurse will arrange a follow-up, either in their office or a home visit.
If you have an IVC filter (inserted for blood clots) or a nephrostomy tube (inserted for a blocked kidney), you will need these removed 6-8 weeks post-op.
If you have swelling of the legs or genital area, you should wear tight compressive underwear, thigh-high lymphoedema compression stockings (from a chemist via prescription) and see your local lymphoedema specialist nurse who has expertise in massage, exercises, appliances and advice.
ACTIVITY AFTER SURGERY
You will be assisted by the hospital physiotherapist to get out of bed on your 1st day post-op and then daily until you no longer need the physio’s help.
You can shower but the wound should be kept dry for 7 days.
You may walk and climb stairs, but wait for 4 weeks before squatting or lifting anything heavier than 5 kgs.
Wait 4 weeks before any heavy exercises such as jogging, swimming or lifting weights.
You may drive after two weeks, as long as you are relatively pain free, thus able to twist your torso in order to check blind spots over your shoulder and able to slam on the brakes without pain (eg if a child or car darted out in front of you).
Avoid sitting with your feet on the floor for long periods; walk around and when sitting, elevate your feet up on a foot-rest/ sofa or bed.
Do not plan any long car trips or plane flight for 4- 6 weeks after the operation to avoid prolonged sitting and DVT risk.
PROBLEMS OR CONCERNS AFTER SURGERY
If you have a problem or concern after surgery, you are always able to contact us at our office, between 9 am and 5 p.m. Monday to Friday on 8046 8050 when we have a nurse to take your call, and we can get in contact with your surgeon urgently if needed.
If the nurse is busy with another patient a message will be taken and we will return your call during the day.
If it is urgent please inform the secretary so they can have the nurse call you back immediately.
If you experience a problem after hours, on the weekend or on a public holiday, please call the hospital where you had your surgery and they will inform your surgeon, or the surgeon on call.
If it is of extreme urgency, please call an ambulance and inform the hospital where you are taken to of your recent surgery and ask them to contact your surgeon. If possible, ask to be taken to either St George or St Vincent’s Hospital emergency where Dr Thompson works, or if you are live outside the southern or eastern Sydney area, attend the emergency department of the public hospital where your local urologist works. I am always happy to be called by any hospital 24/7 if there is an urgent issue with one of my patients. If I am away on conference/ leave, I always arrange a urologist colleague to cover in case of emergencies.