Bladder augmentation is an operation performed to expand or increase the size of a child’s bladder. It is implemented to treat abnormally small bladders or bladders which cannot hold the usual amount of urine. In this procedure, the surgeon makes an incision to expand the bladder and patches it with a portion of the stomach or bowel.
What is it?
Some patients have abnormally small bladders whereas others have bladder muscles lacking the ability to expand properly, inhibiting the bladder from retaining a normal amount of urine. When this happens, urine in the bladder can “reflux” or return to the kidneys and can have issues draining properly. This reflux contributes to urinary tract infections, kidney damage, incontinence, and other bladder conditions.
Bladder augmentation surgery increases the size of the bladder using tissue from the stomach or bowel. The surgeon opens the bladder then removes a segment of the stomach or bowel and uses the tissue to patch the bladder up. The new bladder is composed of stomach/bowel tissue and bladder tissue.
What should I do to prepare?
Diagnostic tests are performed to gauge bladder function and health such as blood tests, X-rays, MRI scans, and bladder pressure studies. An all liquid diet will be required of patients two days before the surgery and is usually paired with a dose of magnesium citrate. For those with renal insufficiency, chronic constipation, or other disorders, it may be best to perform most of the pre-operative tasks during the hospital stay. Laxatives are given to clear the bowels as well as antibiotics in order to prevent infection. Patients cannot eat or drink the evening before the surgery in order to avoid complications with anesthesia such as aspiration. When a patient is put under anesthesia, it is possible for food in the stomach to be expelled into the lungs. To avoid such problems, the patient must not eat or drink the night before the surgery or for the period of time their doctor prescribes.
Additionally, the patient should refrain from taking blood thinners a week before the surgery since these drugs increase the risk of bleeding during the operation. The patient should consult with his or her doctor about the use of blood thinners based on personal health needs since some may require such medications for stroke prevention.
What happens during the process?
The patient will be put under general anesthesia, meaning that he or she will be completely asleep during the operation. The surgeon makes an incision in the abdomen area above the bladder. The incision is made vertically, down the middle. After the incision is made and the surgeon has access to the bladder, the surgeon will cut open the top of the bladder. Then, remove a portion of the bowel or stomach and sew this tissue to the bladder, thus closing it and creating a larger bladder made of combination of bladder tissue and stomach/bowel tissue. The surgery lasts four to eight hours, and many patients will be given an epidural in order to minimize post-surgery pain.
Bladder catheters and suprapubic catheters are left in place for a period of time following the procedure in order to ensure the urine drains properly. The suprapubic catheter remains in place for at least three weeks before it is removed at the hospital.
What are the risks and potential complications?
Risks of bladder augmentation include:
- Infection
- Excessive bleeding
- Bladder/bowel injuries
- Bowel obstructions that develop post-surgery
- Blood clots
- Nerve injuries
- Aspiration
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