Complications of radical cystectomy

Radical cystectomy is major surgery, and complications can involve healing, infection, blood clots, digestion, or the new urinary drainage route. Some problems occur during the initial recovery, while others develop after discharge. Your surgical team will explain which changes are expected for your operation and which need prompt review.

Early concerns include bleeding, wound or urinary infection, chest infection, blood clots, and a temporary slowing of the bowel that causes bloating, nausea, or vomiting. Urine can leak where the urinary tract has been joined, and nearby organs or tissues can be injured during surgery. Later concerns may include narrowing at a urinary connection, kidney drainage problems, hernia, altered bowel habits, sexual difficulties, and changes in body image. A stoma can also develop skin irritation, leakage, or a poor appliance fit. The relevant risks differ between an ileal conduit, neobladder, and continent reservoir.

Follow the discharge plan for wound care, urinary drainage, medicines, food, fluids, and activity. Take prescribed blood-clot prevention exactly as directed and increase walking gradually. Record urine output or catheter issues if the team asks you to do so. If you have a stoma, check the skin and appliance seal when changing the pouch; a stoma nurse can help with persistent leakage or soreness. Contact the surgical team when pain, nausea, constipation, diarrhoea, appetite, or urine flow changes instead of altering prescribed treatment yourself.

Get urgent medical help for sudden shortness of breath, chest pain, coughing blood, fainting, confusion, or a painful swollen leg. Contact the surgical service promptly for fever or chills, worsening abdominal swelling, repeated vomiting, severe or increasing pain, a wound that opens or drains pus, heavy bleeding, very little or no urine, a blocked catheter, or a stoma that becomes dark, unusually pale, or stops draining. Use the emergency service if symptoms are severe or rapidly worsening.

Ask which urinary diversion you will have, how it changes your specific risks, and who to contact outside clinic hours. Clarify how to recognise a urinary blockage or leak, when drains or catheters may be removed, and what bowel changes warrant assessment. You can also discuss sexual function, fertility, stoma support, return to driving or work, and the planned follow-up for kidney function and cancer care.