Bladder enlargement or bladder augmentation surgery is a method of enlarging the bladder in the hope of allowing a patient to reach a state of continence. This method is often considered as a last resort and attempted usually only when all other methods to correct overactive bladder syndrome have failed. There are many things to consider: viability, type of surgery, and risks. Deciding upon bladder augmentation should only come after serious discussion with a urologist or other specialist and after an open talk with family.
Who Are Likely Candidates?
This surgery first and foremost may ultimately not achieve the desired result and leave a patient facing a lifetime of intermittent catheterization. The first consideration should be that a potential candidate has the mental strength and the physical ability (or assistance) to perform daily self-catheterization should this be the outcome. The patient’s health and overall incontinence situation is then evaluated. The surgery works best for those with small bladders and high pressures in the bladder. The ability to experience natural bladder contractions with a normal urethral sphincter response will also increase the likelihood that a person is a viable candidate for bladder enlargement surgery.
What Are the Various Methods of Bladder Augmentation?
Enterocystoplasty – This method is the most commonly used and is often regarded as the benchmark for the other types. Enterocystoplasty uses a piece of the patient’s intestine (in most cases the ileum of the small intestine) to enlarge the bladder. This cross-section of intestine is first cut and flattened from its natural tube shape. This step is critical because it prevents the intestine from naturally contracting, which can actually increase bladder pressure – an undesired outcome. The bladder is open and the new patch secured into place. While the operative site heals, a suprapubic catheter is inserted to allow for urinary outflow. Lastly, before this indwelling catheter is removed a cystogram is performed to ensure that the new patch is leak-proof.
Gastrocystoplasty – Instead of using a patch made from intestine, gastrocystoplasty relies on the patient’s stomach as the source for a bladder patch. A piece of stomach is removed and then sewn into the bladder once the bladder has been opened. The actual surgery is very similar to enterocystoplasty.
Autoaugmentation – The third type of bladder augmentation most commonly seen does not rely on the addition of any new material to the bladder, but actually takes some away. The thick detrusor muscle that surrounds the bladder is removed from a section of the bladder. This prevents that section from contracting normally and helps reduce bladder pressure.
Is Bladder Enlarging Risky?
As with any surgical procedure there are risks to this procedure. Bleeding, urine leakage, and infection are possible, but beyond these risks there are some particular risks to the method used. For those that undergo augmentation with the intestine regular flushing may be needed due to the fact that the intestinal patch may still create mucus and could lead to serious bladder infections and bladder stones. Likewise, the stomach patch may produce enough acid to irritate bladder tissue and lead to painful urination or blood in the urine. All of these risks and others should be carefully explained by the surgeon and weighed against the potential reward.
There are many ways to treat overactive bladder syndrome including bladder medications and physical therapy. Again, bladder surgery should be a last resort and only after a thorough discussion with one or more health professionals who are specialists in incontinence issues.