Bladder augmentation (1069)

(Augmentation cystoplasty)

What is bladder augmentation?

This is a surgery that is done to make the bladder larger. It is done: 

• So the bladder can hold more urine.
• To let the bladder store urine at a low, safe pressure. This helps to protect the kidneys. 

This surgery may be done for patients with neurogenic or non-compliant bladders. 

How is it done?

• A small piece of the intestine is removed to create the augment. Each person has about 24 feet or so of intestine. Most often, less than one foot of intestine is taken. The two ends of the intestine are then reconnected. 
• The piece of intestine is opened up. It is made into an upside down cup shape. That piece is sewn onto the top of the bladder. This makes the bladder larger. 
• The procedure takes about four hours. A bowel clean out before the procedure may be needed. Your doctor will provide more information on this.  
• After this surgery, most patients stay in the hospital for 5 to 10 days. Patients often go home with a suprapubic catheter in the bladder. This catheter comes out of the tummy (abdomen) wall and is attached to a bag. It is left in for about 4 to 6 weeks.

How is the augmented bladder cared for?

You will need to do bladder irrigation with the indwelling catheter. The bowel part of the augmented bladder secretes mucus. This is a normal process for the bowel. If the mucus is not irrigated out of the bladder, it can cause problems like urinary tract infections or bladder stones.

How much to irrigate: ___________   How often to irrigate: _____________

Use tap water or normal saline (NS)) to irrigate the bladder. The doctor will tell you how much tap water or NS to irrigate with and how often you will need to irrigate. 

How to irrigate the bladder: 

1. Using 60ml syringe, draw up the instructed amount of fluid. 

2. Attach the syringe of fluid to the end of the catheter. 

3. Push the directed amount of fluid into the bladder. Then pull the fluid back out, pulling the mucus with it. Discard this into diaper, container or toilet.

4. Repeat the process of drawing up fluid, pushing in fluid and pulling it out until no mucus is seen when you pull the fluid back out. 

Note: Sometimes it may be hard to draw back on the syringe. This may be because the tip of the catheter is against the side of the bladder. You may need to push another syringe of fluid in before getting fluid back out. Do not be surprised if more fluid drains out than what you pushed in. This means a plug of mucus was blocking the catheter.

What are possible complications?

• Bowel obstruction.
• Urinary tract infection (UTI). To help prevent UTIs, drink plenty of water and catheterize as directed by your doctor. 
• A kink in the catheter. If you have noticed urine is not draining, please check the catheter tubing to be sure it is not kinked.
• Bladder spasms can occur and may cause urine to leak. Medicine may be needed. 
• Mucus in the bladder. You will need to do bladder irrigation to clear out mucus.
• Bladder stones. These can occur if:
  - The bladder does not empty completely.
  - Irrigation is not done as often as it needs to be.
• Bladder rupture. This can happen if the augmented bladder is over stretched. An augmented bladder is not able to empty on its own. That is why the bladder must be catheterized as recommended by your doctor. When the bladder ruptures it causes urine to leak into the stomach. This can result in very serious and potentially life threatening infection if not treated right away. 
• Signs of bladder rupture are unusual abdominal pain, with or without fever.

If you or a health care provider think your child may have a bladder rupture, please call the Urology office right away.

Urology office:

• Monday through Friday, 8:00am to 4:30pm: 414-266-3794.
• After 4:30pm, on weekends and holidays, call 414-266-2000.  Ask for the Urology resident to be paged.