Chemo day 23 - planning for the future

I'm feeling ok today, all things considered.  I can tell my cells are at battle with the chemo drugs, and I am at the office but moving more slowly than usual.  I'm just taking one of the anti-nausea medicines (ondansetron), which seems to be keeping the gag reflex at bay.  Along with the MiraLax, so far I seem to be triangulating within that elusive sweet spot somewhere between constipation, diarrhea, and vomiting, although at times I feel myself veering close to one side, then another.  

I recently had the following email exchange with my medical team at Johns Hopkins, where I will have my surgery once chemo is over. 

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Dr. Schoenberg and Nurse Rogers:

Consistent with our discussions, and my consultations with Doctors Kim and Song at JHU, I am completing my first round of chemotherapy (GemCis) under the direction of Dr, Aragon-Ching and GW. I am expecting to have three more rounds with a projected completion in early May.  I then would expect to be scheduled for RC and neobladder by Dr. Schoenberg.  I have some questions to help my preparation, and would appreciate your thoughts.

1.  I understand that the standard surgical procedure is cystoprostatectomy with pelvic lymphadenectomy.  I am concerned about the side effects of the prostate removal, and am trying to understand why a cystoprostatectomy is preformed instead of a cystectomy.  Is it advisable/possible to do a biopsy or other testing first to determine if my bladder cancer has spread to my prostate, and if so, when would that be done?

SCHOENBERG RESPONSE:  BASED ON STUDIES OF CYSTECTOMY SPECIMENS, DAVID WOOD ET AL. PUBLISHED A REPORT DETAILING A 45% INCIDENCE OF OCCULT BLADDER CANCER INVOLVING THE PROSTATE IN PATIENTS UNDERGOING SURGERY FOR BLADDER CANCER. IF WE LEAVE THE PROSTATE IN WE LEAVE CANCER BEHIND IN ABOUT 1/2 OF THE PATIENTS.

2.  What if anything should I be doing in advance to prepare for the surgery, and improve my recovery?  Are there any particular exercises that I should be focusing on the strengthen my abdominal floor or otherwise make my recovery easier?

SCHOENBERG RESPONSE: EXERCISE IN GENERAL IS GOOD. NO EVIDENCE THAT PREOP KEGELS HELP RETURN OF CONTINENCE.

3.  What specific type of neobladder surgery will Dr. Schoenberg perform?  I understand that there are multiple variations, including bowel orthotopic neobladder and continent urinary reservoir using the large intestine/colon.  I would appreciate knowing what exactly he will be doing, so I can do more reading and research.

SCHOENBERG RESPONSE: STUDER TYPE MADE ENTIRELY OF SMALL INTESTINE

4.  I know Dr. Schoenberg is highly regarded, but I nevertheless would like to know how many surgeries of type that he will do on me has Dr. Schoenberg done, and what are the complication rates of his patients?

SCHOENBERG RESPONSE: APPROXIMATELY 300. COMPLICATIONS ARE CONSISTENT WITH THE PUBLISHED LITERATURE AND INCLUDE: URETER STRICTURES IN 9.9 %, INCONTINENCE IN 15%, URINARY TRACT INFECTIONS IN 20%.

5.  What is the minimum and maximum amount of time after completing chemotherapy that the surgery should be done?

SCHOENBERG RESPONSE: 4-8 WEEKS FOLLOWING COMPLETION OF CHEMO.

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What this means is that, assuming that I can complete chemo, I'll probably have the surgery in early June, which will put me out of commission for June and July.