Augmentation Cystoplasty (Bladder Augmentation)

What is bladder augmentation surgery?

Your bladder is an organ that holds your pee (urine). Cystoplasty (bladder augmentation) is a surgery that makes your bladder larger using a section of your small intestine (ileocystoplasty) or large intestine (sigmoid or ceco-cystoplasty).

Why is a cystoplasty performed?

Certain conditions can affect your bladder, including spinal cord injuries, congenital spinal or neurologic problems, or acquired conditions like multiple sclerosis. These conditions may include:

• Leakage of urine.
• Spasticity (stiffness) of your bladder, which can manifest as urgency, urge-related leakage, frequency of urination, or pain in your bladder or genital area.
• Loss of bladder capacity (you can't hold as much urine as prior).
• Your bladder muscles don’t work properly. For example, your bladder may not stretch enough, which increases pressure in your bladder. The bladder pressure may cause kidney infections and kidney damage.

In many cases, your healthcare provider will recommend bladder augmentation after you’ve had to self-catheterize for a long period. Self-catheterization is a procedure in which you insert a thin, hollow tube (catheter) through your urethra (pronounced “yer-ree-thruh”) to drain your urine.

How common are bladder augmentations?

Bladder augmentations are relatively uncommon procedures. In 2009, healthcare providers performed an estimated 595 bladder augmentations.

How long does a bladder augmentation last?

The effects of a successful bladder augmentation surgery are permanent.

What happens before a bladder augmentation?

Before a bladder augmentation, you’ll meet with a healthcare provider. They may perform a series of tests, including:

• Physical exam.
• Blood tests.
• X-rays.
• Cystoscopy.
• Urodynamic testing.

Tell your healthcare provider about any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your risk of bleeding.

What happens during a bladder augmentation?

Surgery may be done through an incision in your abdomen, or through several small poke-holes using a robot (1 in image). Either way, your surgeon:

• Makes a “Pac-man”-like opening at the top of your bladder (2 in image).
• Removes a section of your small or large intestine (3 in image).
• Cuts open (detubularizes) that link of bowel (3).
• Attaches it to the top of your bladder (4 in image).
• Sews your bladder and bowel together to make the bladder larger (5 in image).

When you wake up, you’ll have two or three tubes in your bladder and abdomen. These tubes will help keep your bladder drained as it heals and permit lavage or “washing” of the mucous out of your bladder.

How long does a bladder augmentation take?

A bladder augmentation usually takes two to six hours to perform.

What happens after a bladder augmentation?

Most people stay in the hospital for five to seven days following bladder augmentation. During the first several days, you won’t be able to eat or drink. This is because your bowels become temporarily paralyzed (“ileus”) following this surgery. Sometimes, you may have a tube down your nose that removes the stomach and bowel fluid while the ileus resolves. After the ileus resolves, you’ll start with clear fluids (like gelatin or chicken broth) and, over time, move to more solid food. Typically, people go home about three days after starting their clear liquid diet.

While in the hospital, you’ll have two or more tubes in your abdomen or bladder. Most people have at least two catheters in their bladder for drainage. You’ll also likely have a drain in your pelvis to remove excess abdominal fluid. Within a day or two of your surgery, your healthcare team will start to teach you how to care for these tubes and flush out (irrigate) mucus from your bladder.

After your bladder augmentation, your bowel is in contact with your bladder system. This contact causes mucus to mix with your urine. You must irrigate this mucus regularly for the rest of your life. Most people irrigate the mucus every morning. If you don’t irrigate the mucus, it may cause other conditions, including bladder stones or urinary tract infections (UTIs).

About three weeks after your bladder augmentation, healthcare providers will take imaging tests to ensure that your new, larger bladder isn’t leaking urine. If your bladder isn’t leaking and you’re healing properly, your healthcare provider will remove your tubes and you’ll begin self-catheterizing. Don’t worry! Your care team will teach you how to do this, and make sure you’re comfortable doing it yourself.

How long will I stay in the hospital after a cystoplasty?

Most people stay in the hospital for five to seven days after a bladder augmentation.

What are the advantages of bladder augmentation?

After a successful bladder augmentation, your bladder will increase in size. A larger bladder reduces pressure on your bladder and increases the amount of time needed between going to the bathroom. The goal of this surgery is to create a bladder large enough to hold (and not leak) urine for at least four hours between catheterizations.

What are the risks or complications of bladder augmentation?

As mentioned, if you don’t regularly irrigate the mucus from your bladder, the mucus may clog your catheter and affect your urine flow. It may also cause your bladder to stretch or even tear. The bowel that’s in contact with your bladder may also cause changes to your body chemistry and critical vitamin levels, which will need monitoring throughout your life. You may also develop UTIs and stones in your bladder, particularly if you don’t remove the mucus regularly.

In addition, all surgical procedures carry some risk. Some risks of a bladder augmentation include:

• Anesthesia risks.
• Healing problems.
• Infection.
• Mass of clotted blood (hematoma).
• Swelling.
• Bruising.
• Unfavorable scarring.
• Hernia formation.

How long does it take to recover from a cystoplasty?

Most people recover to about 90% of their baseline after six weeks. However, it often takes up to three months to get completely back to your pre-operative baseline. Avoid strenuous physical activity, including lifting, running, playing sports and having sex. Physical activity may put pressure on your abdominal wall and increase risk of hernia formation.

It’s important to remember that your body is unique. Your recovery time may vary. It’s important to follow your healthcare provider’s instructions as you heal.

When can I go back to work or school?

Most people return to work or school six weeks after their bladder augmentation, depending on the nature of their work and how their recovery is going.

When should I see my healthcare provider?

Your provider will schedule follow-up appointments. They’ll want to check your incision and take your stitches out around the three-month mark, which is when they’ll remove some (or all) of the bladder tubes. Then, you’ll go in every year or so for kidney imaging, routine lab work and to renew your catheter prescription.

Call your healthcare provider immediately if you aren’t feeling well or experience any abnormal symptoms after your procedure, including:

• Heavy bleeding around your incision.
• A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher. ·
• Infection or increased pain or swelling in your affected area.

A note from Cleveland Clinic

A bladder augmentation will make your bladder larger so it can hold more urine and improve your quality of life. Many people have to self-catheterize for the rest of their lives after a bladder augmentation. The purpose of augmentation cystoplasty is to provide reliable urinary continence and protect your kidneys from back pressure from your bladder. Talk to your healthcare provider about whether a bladder augmentation is right for you. They can answer and address your questions and concerns.