Bladder augmentation is a surgical procedure performed to increase the storage capacity of the bladder and improve its function. The operation is typically performed on children who have severe incontinence issues due to congenital bladder defects, nerve dysfunction, or other conditions that impair urinary control. Bladder augmentation involves extracting a piece of the small intestine and attaching it to the bladder to form a pouch. It is usually an open surgical procedure that requires a lengthy stay in the hospital and special aftercare measures at home. The majority of patients who undergo surgery are able to make full recoveries, though they may need to use catheters and take medications for the rest of their lives to prevent complications in the future.
A child may need bladder augmentation if he or she has an especially small or malformed bladder because of a congenital defect. Multiple sclerosis, spina bifida, and traumatic injuries that damage nerve and muscle functioning can also cause incontinence and require surgery. Before considering the invasive operation, a team of doctors will usually attempt to treat the underlying problem with more conservative techniques, such as catheterization and drug therapy. If all other methods fail to provide lasting relief, a consultation can be scheduled with a specialty surgeon to discuss the procedure in detail.
Most patients need to be hospitalized at least two days before bladder augmentation for preoperative preparation. Enemas and a special liquid diet help to cleanse the intestines so a section can be safely removed during surgery. Before the procedure, the patient is given a general anesthetic, a sedative, and an intravenous line to provide fluids and medication. The surgeon makes a long cut along the lower abdomen to gain access to the bladder and bowel. Next, a piece of the small intestine is carefully removed and the remaining tissue is sutured back together.
The surgeon then separates the bladder from the ureter, the tube that carries urine to the urethra. Intestinal tissue is grafted to the base of the bladder and shaped to form a collection pouch. It is reattached the ureter, and a catheter is put into place to help drain the bladder while tissues undergo healing. The surgical wound is closed with stitches and dressed with antibiotics and bandages.
Following bladder augmentation, the patient is generally kept in the hospital for about two weeks for monitoring. If recovery goes as planned, he or she can go home with the catheter still intact. Parents, caregivers, or visiting nurses are responsible for cleaning the catheter and changing urine collection bags on a daily basis. For most children, full recovery can be expected in about three or four months. Patients who do not regain the ability to control urination because of nerve problems need to continue using catheters their entire lives.