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Bladder Augmentation—Open Surgery

(Augmentation, Bladder—Open Surgery; Augmentation Cystoplasty—Open Surgery; Cystoplasty, Augmentation—Open Surgery)

by Rebecca J. Stahl, MA

Definition

Reasons for Procedure

Possible Complications

What to Expect

Call Your Doctor

En Español

Definition

Bladder augmentation is surgery to increase bladder size.

The Urinary Tract

Reasons for Procedure TOP

Bladder augmentation surgery makes the bladder large enough to collect urine. When the bladder is too small, urine can leak out of the body (incontinence) or back up into the kidneys (reflux). This can cause a kidney infection and could damage the kidneys. The procedure is used to treat serious forms of incontinence after other treatments have failed.

Birth defects and other conditions, like chronic obstructive bladder damage, can cause the bladder to be too small.

Surgery may also be done if you have:

An overactive bladder—bladder muscle contracts when it does not need to, leading to urine leakage
A neurogenic bladder—problems with nerve signals leading to the brain and muscles, leading to urine leakage or retention

Possible Complications TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

Excess bleeding
Reaction to anesthesia
Infection
Blood clots
Bladder rupture
Abdominal pain
Urinary incontinence—may be for a short time or require more surgery to fix
Increased risk of kidney stones

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

Smoking
Drinking
Chronic diseases, such as diabetes or obesity

What to Expect TOP

Prior to Procedure

Your doctor will:

Order tests, like blood and urine tests, x-rays, ultrasounds, and bladder pressure studies.
Talk to you about your medications. You may be asked to stop taking some medications up to 1 week before the surgery.

Before surgery, your doctor may recommend that you:

Eat a low-fiber diet.
Take antibiotics.
Cleanse your bowel—You will drink a special liquid that causes loose stool. The liquid may also be given through a tube placed in the nose down to the stomach.

Anesthesia

General anesthesia will be used. It will block pain and keep you asleep through the surgery.

Description of the Procedure TOP

An incision will be made in the abdomen. An incision will also be made on the top part of the bladder. A part of the intestine or stomach will be removed and placed over the opening in the bladder. This new part will work like a patch. The doctor will sew it into place.

A stoma may also be created. This is a small opening through the abdominal wall to an opening at the top of the bladder. This will make it easier for you to insert the catheter into the bladder.

Immediately After Procedure TOP

A catheter will be left in place to drain urine from the bladder.

You may be given fluids, pain medications, and antibiotics through an IV. A tube will be placed through your nose to your stomach. This tube will keep your stomach drained of any contents. It will stay in place until your stomach and intestines begin working normally.

How Long Will It Take? TOP

4-8 hours

How Much Will It Hurt? TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay TOP

The usual stay is 6-10 days. If you have any problems, you will need to stay longer.

Post-procedure Care TOP

At the Hospital

After your procedure, the hospital staff will:

Give you fluids and nutrients through an IV—You will not be able to eat until your intestines are working normally. This may take several days. When you are ready, the tube in your nose will be removed. You will begin to take fluids by mouth. You will slowly progress to soft foods.
Have you take deep breaths to keep your lungs clear
Prompt you to walk
Teach you how to insert the catheter through the urethra or through the stoma—Depending on your recovery, the catheter that was placed during surgery may be removed before you go home. If so, you will be taught how to catheterize yourself at home using a tube.
Teach you how to wash out the bladder using a salt water solution and a catheter

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

Washing their hands
Wearing gloves or masks
Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

Washing your hands often and reminding your healthcare providers to do the same
Reminding your healthcare providers to wear gloves or masks
Not allowing others to touch your incision

At Home

To help ensure a smooth recovery:

If you have a catheter, follow the instructions for taking care of it. You may see bloody urine for a few weeks.
If you are catheterizing yourself, carefully follow the guidelines for emptying your bladder.
Irrigate the bladder as instructed. This is especially important if you have a piece of the intestine attached to your bladder. The intestine patch will continue to make mucus. This can clog the catheter tube.
Follow your doctor's instructions.

Call Your Doctor TOP

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

Signs of infection, such as fever and chills
Redness, swelling, increasing pain, bleeding, or discharge from the incision and/or stoma site
Nausea and/or vomiting
Abdominal pain
Little urine output, extreme cloudiness or pus in the urine, a bad odor to the urine
Difficulty with catheterizing or irrigating

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

Health Canada
http://www.hc-sc.gc.ca

References:

Bladder augmentation. Boston Children’s Hospital website. Available at:
...(Click grey area to select URL)
Accessed June 1, 2016.

Bladder augmentation (enlargement). Urology Care Foundation website. Available at:
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Accessed June 1, 2016.

Bladder augmentation surgery FAQ. UCSF Benioff Children’s Hospital website. Available at: https://www.ucsfbenioffchildrens.org/education/bladder_augmentation_surgery/index.html. Accessed June 1, 2016.

Continent stomas. Case Western Reserve University/MetroHealth Medical Center website. Available at:
...(Click grey area to select URL)
Accessed June 1, 2016.

6/6/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: A systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

Last reviewed June 2016 by Adrienne Carmack, MD
Last Updated: 5/28/2014

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