Cystoplasty (Bladder Augmentation): Procedure, Risks & Benefits

Augmentation cystoplasty, also known as bladder augmentation, is a surgery to make the bladder larger. (The bladder is the organ that holds urine.)

Why is augmentation cystoplasty performed?

Augmentation cystoplasty is performed in people who have trouble urinating because of certain health problems or conditions. These include the following:

Figure 1

• Incontinence, the inability to hold urine (wetting).
• The muscles of the bladder are not working properly. For instance, the bladder may not stretch normally, which increases pressure in the bladder. This may cause pressure to back up to the kidneys (reflux), which can cause kidney infections and damage the kidneys. Augmentation cystoplasty can decrease pressure in the bladder.
• Spasticity (stiffness) of the bladder.
• Shrinking of the bladder caused by treatments (e.g., radiation) or diseases (e.g., spinal cord injury).

In many cases, augmentation cystoplasty is performed after the patient has performed self-catheterization for a period of time. Self-catheterization is a procedure in which the patient inserts a catheter (a thin, hollow tube) through his or her urethra (the tube through which urine comes out of the body) in order to drain urine.

Figure 2

How is augmentation cystoplasty performed?

Augmentation cystoplasty is a type of abdominal surgery, which means that the surgeon makes an incision (cut) in the patient’s abdomen to get to the bladder (Figure 1).

After making the incision in the abdomen, the surgeon cuts open the bladder at the top to prepare it for enlarging (Figure 2).

The surgeon then removes a section of the small or large intestine (Figure 3); detubularizes (cuts open) that link of bowel (Figure 3), and attaches it to the top of the bladder (Figure 4). The bladder and bowel are then sewn together to make the bladder larger (Figure 5).

Figure 3

Figure 4

Figure 5

What happens before augmentation cystoplasty surgery?

Before the augmentation cystoplasty is performed, the patient will have a series of tests and examinations, including:

• Physical exam.
• Examination of the bladder (usually cystoscopy or radiological imaging).
• A test to see how well the patient holds urine and how full the bladder is before it starts to leak or transmit pressure to the kidneys.

The patient will also perform a bowel prep, in which he or she drinks a solution that will clean out his or her bowel before surgery.

What happens after the augmentation cystoplasty surgery?

After the augmentation cystoplasty surgery, the patient will stay in the hospital, usually for five to seven days. He or she will probably not be able to eat or drink for a couple days after surgery, and will receive fluids through an intravenous (IV) line.

While in the hospital, the patient will have at least two and possibly more tubes in his or her abdomen and bladder. Nurses and physicians will instruct the patient on how to care for these tubes and irrigate mucous out of the bladder, beginning immediately after surgery.

Figure 6

Because the bowel is now in contact with the bladder system, the patient should expect that the urine will have mucous in it. The patient will have to irrigate this mucous on a regular basis (usually every morning) for the remainder of his or her life. If it is not irrigated out, the mucous can form stones and the patient will need additional operations to remove these stones. Retained mucous will also lead to a greater risk for infections in the urinary tract.

Three weeks after the surgery, the patient will have a radiology test to make sure that the new, larger bladder is not leaking. If that test is deemed okay, then the tubes will be removed and the patient will be instructed on self-catheterization and irrigation in the clinic. The patient should be able to resume normal activities, including returning to work, approximately 6 weeks after the surgery.

Because the bladder is only partially made of bladder muscle, the patient should expect to not be able to empty his or her bladder by voiding (urinating) alone after surgery. The patient will most likely require self-catheterization for the remainder of his or her life to empty his or her bladder. In some cases, a new channel is created during bladder augmentation surgery so that the patient may pass a catheter through his or her belly button to empty (Figure 6).