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Bladder Augmentation—Laparoscopic Surgery

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

by Rebecca J. Stahl, MA

Definition

Bladder augmentation surgery increases bladder size. It can be done laparoscopically.

The Urinary Tract

The Urinary Tract
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

Bladder augmentation surgery makes the bladder large enough to collect urine. When the bladder is too small, it can cause urine to leak out of the body (incontinence) or back up into the kidneys ( reflux). This can cause a kidney infection and damage the kidneys. This procedure is used to treat serious cases 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, causing urine leakage
  • A neurogenic bladder —problems with nerve signals leading to the brain and muscles, causing urine leakage or retention

Possible Complications    TOP

Complications are rare. But no procedure is free of risk. Complications may include:

  • Excess bleeding
  • Reaction to anesthesia
  • Infection
  • Heart attack
  • Blood clots
  • Throat soreness
  • Nausea and vomiting
  • Bladder rupture
  • Abdominal pain
  • Switching to open surgery
  • Urinary incontinence (may be temporary or require more surgery to fix)
  • Increased risk of kidney stones

Smoking may increase the risk of complications.

Discuss these risks with your doctor.

What to Expect    TOP

Prior to Procedure

Your doctor will:

  • Order tests, such as blood and urine tests, x-rays, ultrasounds, and bladder pressure studies
  • Talk to you about your medicines—You may be asked to stop taking some medicines up to one week before the surgery, like:
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Clopidogrel (Plavix)

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 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.

Description of the Procedure

The doctor will make several small, keyhole incisions in the abdomen. A laparoscope will be inserted. This gives the doctor a clear view of the inside of the abdomen.

An incision will be made on the top part of the bladder. The doctor will use tools, like clips and staplers, to remove a piece of the intestine or stomach. After this piece is cut out, a suturing device will be used to close the incision. Next, the doctor will attach the piece of the intestine or stomach to the bladder.

In some cases, the doctor will also create a stoma. This is a small opening through the abdominal wall to an opening that is made at the top of the bladder. These openings will make it easier for you to insert the catheter into the bladder.

Depending on the method your doctor uses, a combination of open and laparoscopic procedures may be done. If you do need open surgery, you will have a larger incision and a longer recovery time.

Immediately After Procedure

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

You may be given fluids, pain medicines, 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. This will stay in place until your stomach and intestines begin working normally again.

How Long Will It Take?

About four hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Your doctor will give you pain medicines after surgery.

Average Hospital Stay

The usual hospital stay is 3-5 days. If you have any problems, you will need to stay longer.

Post-procedure Care

At the hospital, the 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
  • Encourage 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 irrigate the bladder using a saline (salt water) solution and a catheter

At home, do the following to help ensure a smooth recovery:

  • Take medicine as directed.
  • Clean the incision areas with warm water and gentle soap.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Eat a healthy diet and drink plenty of fluids.
  • 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 directed. 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.
  • Do not drive or do difficult physical activities until the doctor says it is okay.
  • Return to the doctor in 3-4 weeks for x-rays of the bladder.
  • Follow your doctor’s instructions.

Call Your Doctor    TOP

Contact your doctor if any of the following occurs:

  • 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, pus in the urine, or a bad odor to the urine
  • Difficulty with catheterizing or irrigating

In case of an emergency, call for medical help right away.

RESOURCES:

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.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. Case Western Reserve University/MetroHealth Medical Center website. Available at: http://www.chrp.org/empowering/ba.shtm . Accessed December 12, 2012.
Bladder augmentation. Children’s Hospital Boston website. Available at: http://www.childre... . Accessed December 12, 2012.
Bladder augmentation. UrologyHealth.org website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=56 . Updated January 2011. Accessed December 12, 2012.
Bladder augmentation surgery FAQ. UCSF Benioff Children’s Hospital website. Available at: http://www.ucsfben... . Accessed December 12, 2012.
Continent stomas. Case Western Reserve University/MetroHealth Medical Center website. Available at: http://www.chrp.org/empowering/cs.shtm . Accessed December 12, 2012.
Docimo S. Laparoscopic bladder augmentation: state of the art. Pediatric Endosurgery & Innovative Techniques. 2000;4(3):207-211.
Endoscopic clip application devices. American Society for Gastrointestinal Endoscopy website. Available at: http://www.asge.or... . Published 2006. Accessed December 12, 2012.
Smith A. Smith’s Textbook of Endourology. Hamilton, Ontario: BC Decker; 2007:865,868.
Sweeney DD, Smaldone MC, Docimo SG. Minimally invasive surgery for urologic disease in children. Nat Clin Pract Urol. 2007 ;4(1):26-38.
6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed December 2012 by Adrienne Carmack, MD
Last Updated: 12/12/2012