Carl R. Darnall Army Medical Center - Health Library

Bladder Augmentation—Laparoscopic Surgery

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

Definition

Bladder augmentation makes the bladder bigger.

The Urinary Tract
The Urinary Tract

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Reasons for Procedure  ^

Bladder augmentation makes the bladder large enough to collect urine. When the bladder is too small, it can cause urine to leak out of the body or back up into the kidneys. This can cause an infection in the urinary tract, causing harm to the kidneys. It’s also used when other care methods fail.

Problems, such as long term blockage or birth defects, can cause the bladder to be too small.

Other reasons:

  • Bladder muscle problems causing urine to leak—overactive bladder
  • Nerve problems with the bladder causing urine to leak or be retained—neurogenic bladder

Possible Complications  ^

Problems from the procedure are rare, but all have some risk. Your doctor will review potential problems such as:

  • Excess bleeding
  • Reaction to anesthesia
  • Infection
  • Blood clots
  • Bladder rupture
  • Switching to an open procedure
  • Incontinence—may be temporary or require more surgery to fix
  • Higher risk of kidney stones

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect  ^

Prior to Procedure

You may have:

  • Blood and urine tests
  • Imaging tests such as x-rays, ultrasounds, or bladder pressure studies

Talk to your doctor about the medicines you take. You may need to stop them up to 1 week prior to the procedure.

Before surgery, your doctor may advise you:

  • Eat a low-fiber diet.
  • Take antibiotics.
  • Use a prep to clean out your bowels.

Anesthesia

General anesthesia—will block pain and keep you asleep

Description of the Procedure

Several small, keyhole incisions will be made in your belly. A laparoscope will be inserted. This gives the doctor a clear view of internal structures.

An incision will be made on the top part of the bladder. Small surgical tools remove a piece of the intestine or stomach. After removal, the area will be stitched. Next, a piece of the intestine or stomach will be attached to the bladder.

In some cases, a small opening called a stoma will be made. The stoma comes through the belly wall to an opening that is made at the top of the bladder. These openings help make it easier to insert the catheter.

Your doctor may need to change to an open procedure. If this happens, you will have a larger incision. The healing time takes longer as well.

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. This may be done through an IV. A tube will be placed through your nose to your stomach. This tube will keep your stomach drained. This will stay in place until your stomach and intestines begin working normally again.

How Long Will It Take?

About 4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medicines.

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 healthcare staff will:

  • Give you fluids and nutrients through an IV—You will not be able to eat until your intestines are working again. This may take a few days. Then, the tube in your nose will be removed. You will start to take fluids by mouth. You will slowly move to soft foods.
  • Have you take deep breaths to keep your lungs clear.
  • Have you walk around.
  • Teach you how to use the catheter. It’s placed through the urethra or through the stoma. If you’re better, the catheter placed during surgery will be taken out.
  • Teach you how to wash out the bladder using salt water and a catheter.

During your stay, the healthcare staff will take steps to lower your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your chance of infection such as:

  • Washing your hands often and reminding your healthcare staff to do the same
  • Reminding your healthcare staff to wear gloves or masks
  • Not letting others touch your incision

At Home

To help you get healthier faster:

  • Follow the directions in caring for your catheter. You may see blood in the urine for a few weeks.
  • If you are catheterizing yourself, carefully follow the plans for draining your bladder.
  • Wash out the bladder as advised. 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.

Call Your Doctor  ^

Call your doctor if any of these occur:

  • Fever or chills
  • Signs of infection from the incision or stoma:
    • Redness
    • Swelling
    • Pain
    • Bleeding
    • Pus
  • Nausea or vomiting
  • Belly pain
  • Urinary problems such as:
    • Little output
    • Extreme cloudiness
    • Presence of pus
    • Bad odor
  • Trouble placing the catheter or washing it out

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https//www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The Kidney Foundation of Canada
https://www.kidney.ca

REFERENCES:

Bladder augmentation. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/treatments/bladder-augmentation. Accessed June 13, 2018.

Bladder augmentation (enlargement). Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/bladder-augmentation-(enlargement). Accessed June 13, 2018.

Bladder augmentation surgery FAQ. UCSF Benioff Children’s Hospital website. Available at: https://www.ucsfbenioffchildrens.org/education/bladder_augmentation_surgery/index.html. Accessed June 13, 2018.

Sweeney DD, Smaldone MC, Socimo SG. Minimally invasive surgery for urologic disease in children. Nat Clin Pract Urol. 2007;4(1):26-38.

Technology Assessment Committee, Chuttani R, Barkun A, et al. Endoscopic clip application devices. Gastrointest Endosc. 2006;63(6):746-750.

6/2/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use: 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.

Last reviewed June 2018 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 6/13/2018