Augmentation Cystoplasty (Bladder Augmentation)
What is bladder augmentation surgery?
Your bladder is an organ that holds your urine. Cystoplasty (bladder augmentation) is a surgery that makes your bladder larger using a section of your small intestine (ileocystoplasty) or large intestine (sigmoid 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 (i.e., you cannot 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 (yer-ree-thruh) to drain your pee.
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 your healthcare provider. They may perform a series of tests, including:
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?
An anesthesiologist (an-es-thee-si-ol-oh-gist) will insert an intravenous (IV) line into a vein in your arm or hand. The IV delivers anesthesia into your body, so you aren’t awake and won’t feel any pain during the surgery.
Your healthcare providers may need to prepare the area by shaving your stomach (abdomen). They’ll sanitize your skin with an antiseptic to kill any bacteria.
Surgery may be done through an incision in your abdomen, or through several small poke-holes using a robot. Either way, the bladder will be opened up like a “Pac-man” and a patch of bowel placed in the opening. This has the effect of making a urinary reservoir that is half-bladder and half-intestine. Sometimes, you will have a small channel (called a “Mitrofanoff” or catheterizeable channel) constructed at the same time that will permit passage of the catheter into your new bladder to drain it.
When you wake up, you will 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?
After the bladder augmentation is complete, your anesthesiologist will stop putting anesthesia in your body.
You’ll move to a recovery room, where healthcare providers will wait for you to wake up and monitor your overall health.
You won’t be able to eat or drink for at least a few days after surgery as your body heals. You’ll receive fluids through an IV line.
While in the hospital, you’ll have two or more tubes in your abdomen or bladder. After you wake up and regain your senses, healthcare providers will 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 pee. You must irrigate this mucus regularly for the rest of your life. Most people irrigate the mucus every morning.
About three weeks after your bladder augmentation, healthcare providers will take imaging tests to ensure that your new, larger bladder isn’t leaking pee. If your bladder isn’t leaking and you’re healing properly, your healthcare provider will remove your tubes.
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.
Risks / Benefits
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 between needing to go to the bathroom.
What are the risks or complications of bladder augmentation?
Your intestines secrete mucus. 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 is in contact with your bladder may also cause changes to your body chemistry and critical vitamin levels, which will need to be monitored throughout your life. You may also develop UTIs more frequently.
In addition, all surgical procedures carry some risk. Some risks of a bladder augmentation include:
- Anesthesia risks.
- Healing problems.
- Mass of clotted blood (hematoma).
- Unfavorable scarring.
- Hernia formation.
Recovery and Outlook
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.
When to Call the Doctor
When should I see my healthcare provider?
Schedule follow-up appointments with your healthcare provider. 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 removed.
Call your healthcare provider immediately if you aren’t feeling well or experience any abnormal symptoms after your procedure. Symptoms may include heavy bleeding around your incision, a fever of 100 degrees F (38 degrees C) 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 that 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 the bladder. You must flush out mucus from your bladder and catheters to prevent blockages that may lead to other conditions.
Talk to your healthcare provider about whether a bladder augmentation is right for you. They can answer your questions and concerns.
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