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Bladder Augmentation (Enlargement)

The bladder is a balloon-like organ in the lower half of the abdomen, which stores urine and expels urine when it is full. If the bladder isn't large enough to hold the usual amount of urine made by the kidneys, a bladder enlargement or augmentation may be necessary.

What happens under normal conditions?

The urinary tract is made up of two kidneys, two ureters, a bladder, and a urethra. The kidneys are located just below the ribs and filter blood, retaining valuable proteins glucose, salts and minerals, and removing waste (urine) from the body. The urine flows from the kidneys through two long tubes called the ureters, and then collects in the bladder.

The bladder is expandable so that it can store urine until it can be conveniently emptied. When one urinates, the bladder empties, and the urine flows through the urethra out of the body.

What is bladder augmentation?

Bladder augmentation is an operation performed to increase the size of the bladder. This type of surgery is for patients whose bladder is not large enough to hold the usual amount of urine made by the kidneys. In some patients, the urine may leak from the bladder, causing wetting (incontinence).

For other patients, the bladder muscle may lose its ability to stretch (expand). If this happens, pressure within the bladder can become too high. This increased pressure may be harmful to the kidneys because urine may not drain properly. This may also cause the urine to back up through the ureters all the way to the kidneys. This backup is called reflux.

The result of any of the scenarios listed above may be wetting, urinary tract infections and possible kidney damage.

How is bladder augmentation performed?

Bladder augmentation is performed to decrease the pressure within the bladder, to increase the size of the bladder or to improve its ability to stretch (expand). A section of the bowel or stomach is used. During the operation, the surgeon makes an incision in the abdomen (belly) and the top of the bladder is opened so that it can be made larger. A section is removed from the bowel or stomach, which is placed over the opening in the bladder as a patch, and then sewn into place.

What can be expected after bladder augmentation?

Following a bladder augmentation, the bladder may not be able to expel the stored urine by itself. As a result, many patients must learn to pass a tube backwards through the urethra or through a specially created conduit into the bladder to catheterize themselves, so that they can empty the bladder if they cannot drain it by urinating alone. This is called clean intermittent catheterization (CIC). If the bladder cannot empty itself it is important to pass a tube (catheter) regularly so that the bladder does not over expand and rupture.

Before bladder augmentation surgery, routine tests are done to measure the function and structure of the bladder and kidneys. These tests may include blood tests, X-rays and bladder pressure studies (urodynamics). The same tests may be done after surgery to make sure that the bladder is healing.

Frequently asked questions:

How does a patient get ready for surgery?

A few days before surgery, the patient may need to start a low fiber diet and begin taking antibiotics to prepare the bowel for surgery. The day before surgery the patient comes to the hospital and the doctor may recommend that the patient have clear liquids only.

What is a bowel prep, also known as a "clean out?"

A bowel prep, or "clean out," is cleansing of the bowel using a special liquid. The liquid comes in the form of a drink that can be swallowed or dripped into the stomach through a narrow tube called a nasogastric tube. During this cleansing, patients should expect to have several loose stools. The bowel prep may take four to six hours to complete. When the stools are clear and watery, the bowel prep is finished.

Why is a bowel prep needed?

A bowel prep may be necessary to prevent infection. It makes the bowel as clean and free of contamination as possible.

When will the patient be able to eat and drink after the surgery?

The patient will not be able to eat or drink for as long as one week after surgery. The patient will receive all fluids, "food" and medicines through an IV tube in the arm. The doctors and nurses will listen to the abdomen each day. Soon after the lower belly begins to make "gurgle" sounds again, the patient may be ready to start eating but this will be determined by the doctor. The patient will start with clear fluids, and soon afterwards, will be able to eat regular food again.

When will the patient be able to go back to school or work?

Most patients are ready to return to their regular activities within a few weeks after leaving the hospital. However, each person is different, and some may not be ready to resume regular activities until three to four weeks after leaving the hospital.