What is Urology?

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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Post-Surgical Recovery Process

Recovery varies significantly depending on the procedure. For endoscopic surgeries like TURBT, recovery is rapid. Patients often go home the same day or the next. A catheter may be left in place for 24-48 hours if the resection was deep. The primary instruction is to drink plenty of water to flush out any blood clots.

For major surgery like Radical Cystectomy, the hospital stay is typically 5 to 10 days. Liv Hospital employs ERAS (Enhanced Recovery After Surgery) protocols. This involves getting patients out of bed and walking on the day of surgery, minimizing opioid use to prevent bowel paralysis (ileus), and early reintroduction of food.

  • Pain Management: We use multimodal analgesia (blocks, non-narcotic meds) to keep patients comfortable without the heavy sedation of morphine.
  • Drains and Tubes: Patients wake up with a drain in their abdomen and ureteral stents to protect the new connections. These are removed sequentially over the first 2-3 weeks.
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Rehabilitation of the Neobladder

Rehabilitation of the Neobladder

For patients who receive a Neobladder, the “recovery” involves a period of training. The new bladder typically starts with a small capacity and must be stretched over time.

  • Timed Voiding: Because the intestine doesn’t have the same sensation as a normal bladder, the patient won’t feel the “urge” to go. They must void by the clock—initially every 2 hours, day and night—to prevent overstretching.
  • Mucus Management: The intestine naturally produces mucus. Patients must learn to irrigate their neobladder with saline to prevent mucus plugs from blocking the flow.
  • Continence Training: Nighttime incontinence is common in the first 6-12 months. Patients perform pelvic floor exercises to strengthen the sphincter and may wear pads at night until complete control is gained.
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Living with a Stoma (Ileal Conduit)

Living with a Stoma (Ileal Conduit)

Patients with a urostomy work closely with our certified Wound, Ostomy, and Continence (WOC) nurses.

  • Appliance Skills: Learning how to measure the stoma (which shrinks over the first few weeks), cut the wafer, and apply the bag to ensure a leak-proof seal.
  • Skin Care: Protecting the skin around the stoma from urine irritation is paramount.
  • Hydration: Patients with ileal conduits are prone to dehydration and electrolyte imbalances because they lack the colon’s resorptive function. Maintaining high fluid intake is a lifelong requirement.
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Long-Term Surveillance: The Key to Survival

Long-Term Surveillance: The Key to Survival

Bladder cancer has one of the highest recurrence rates of any malignancy. Therefore, “once a bladder cancer patient, always a bladder cancer patient” in terms of follow-up.

  • For NMIBC (Surface Cancer): Cystoscopy is performed every 3 months for the first 2 years, then every 6 months, then annually. CT scans are performed annually for high-risk patients.
  • For MIBC (Invasive Cancer): Surveillance involves CT scans of the chest, abdomen, and pelvis every 3-6 months for the first 2 years to catch distant metastasis early. Blood work is monitored for kidney function and nutritional status.
  • Functional Surveillance: Patients with urinary diversions need long-term monitoring of their Vitamin B12 levels (absorbed in the ileum) and blood acidity (metabolic acidosis), which can be managed with oral bicarbonate supplements.

Lifestyle Modifications and Prevention of Recurrence

  • Smoking Cessation: This is non-negotiable. Continuing to smoke after a bladder cancer diagnosis significantly increases the risk of recurrence and progression. Liv Hospital offers smoking cessation support programs.
  • Diet and Fluid: Drinking at least 2.5 liters of water daily helps dilute carcinogens in the urine. Diets rich in cruciferous vegetables (such as broccoli and cauliflower) have shown some protective benefits.
  • Occupational Safety: Patients returning to industrial jobs must adhere strictly to safety protocols and use protective gear to avoid chemical exposure.
Lifestyle Modifications and Prevention of Recurrence

Psychological and Sexual Support

  • Bladder diseases affect body image and intimacy. Men may experience erectile dysfunction after cystectomy, and women may experience changes in vaginal sensation.

    • Sexual Rehabilitation: We offer penile rehabilitation (PDE5 inhibitors, injections, or implants) for men.
    • Support Groups: Connecting with other “ostomy” or “neobladder” patients is incredibly vital for mental health. Knowing they are not alone helps patients adapt to their “new normal.”

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FREQUENTLY ASKED QUESTIONS

Will I leak urine with a Neobladder?

 In the beginning, yes. Daytime continence is usually achieved within 3-6 months. Nighttime continence takes longer (6-12 months) because the sphincter relaxes during sleep. About 20% of patients may continue to wear a pad at night for security.

If you have a urinary diversion (conduit or neobladder), mucus is normal. The intestine naturally produces mucus to lubricate stool. It will continue to do so in the urinary tract. Staying well-hydrated helps keep the mucus thin and easy to pass.

Initially, every 3 months. If you remain cancer-free for 2 years, we space it out to every 6 months, and eventually to once a year. However, because bladder cancer can come back even 10 or 15 years later, lifelong annual checks are usually recommended.

Yes. Bacteria can travel from the skin or stoma into the kidneys. Signs of infection include fever, foul-smelling urine, flank pain, or blood in the urine. Because urine samples from the bag are always contaminated, a sterile catheter sample must be obtained directly from the stoma.

Similar to phantom limb pain, patients who have had their bladder removed may still feel the “urge” to urinate or pain in the bladder area. This is due to the brain’s habituation to receiving signals from that area. It usually fades over time.

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