Bladder dilation surgery causes symptoms and recovery steps

Some medical conditions cause chronic bladder issues, such as difficulty retaining urine or frequent urination, which can greatly impact daily life and sleep. Fortunately, bladder augmentation surgery offers an effective solution to improve the bladder's storage capacity and reduce pressure on the kidneys, significantly enhancing the quality of life. In this article from Dally Medical, we will explore the reasons for needing surgery, the symptoms that require it, the steps of the procedure, recovery after surgery, and whether it is safe or risky, all in a simplified and easy-to-understand manner.

What is Bladder Augmentation?

Bladder augmentation is a surgical procedure designed to increase the size of the bladder and improve its ability to hold urine. This procedure is particularly useful in cases of a small bladder or neurogenic bladder caused by nerve diseases or spinal cord injuries.

Who Needs Bladder Augmentation?

Individuals suffering from frequent urinary incontinence or difficulty controlling urine.
People with neurogenic bladder due to spinal cord injury or nerve diseases.
Patients with a small bladder that puts pressure on the kidneys, potentially damaging kidney function.

Methods of Bladder Augmentation

There are several methods for bladder augmentation:

Enterocystoplasty (Using a part of the intestine): The most common method for significantly increasing the bladder size.
Auto-augmentation (Expanding part of the bladder itself): This method does not involve the use of intestines and is suitable for certain cases.
Bioaugmentation (Using engineered cells to form new tissue): A modern method that reduces the complications of using intestines.
Rarely, using other body tissues: This is for exceptional cases where the previous methods cannot be used.

Is the Surgery Safe?

The surgery is generally safe but, like any major operation, it comes with some risks:

Infection or bladder stones.
Difficulty completely emptying the bladder after surgery.
Digestive problems if a part of the intestine is used.

Recovery Time After Surgery

Hospital stay: 5–10 days to monitor the basic functions of the bladder and kidneys.
Early recovery at home: 2–4 weeks with rest and avoiding heavy physical exertion.
Full recovery: 6–12 weeks depending on the patient’s condition and response to the surgery.

Will I Need a Catheter After Surgery?

Some patients may need a temporary catheter to empty the bladder during the first few weeks.

In rare cases, a permanent catheter may be necessary depending on bladder function after the surgery.

Does the Surgery Address the Original Cause of a Small Bladder?

No, the surgery treats the symptoms and protects the kidneys, but it does not cure the underlying cause of the problem.

Can Medications Replace Surgery?

Medications help control symptoms such as overactive bladder or frequent urination, but they do not increase bladder size. Surgery is the permanent solution for bladder enlargement.

Does Bladder Augmentation Affect Sexual Function or Fertility?

Typically, the surgery does not affect sexual function or fertility in men or women. In some special cases, there may be temporary effects on comfort during urination.

Is the Pain After Surgery Severe?

Pain is generally moderate and can be managed with pain relievers. It gradually decreases during the first few weeks after the surgery.

Is the Surgery Suitable for Children?

Yes, especially for children who have neurogenic bladder problems or bladder growth issues. Each case is assessed individually before making a decision.

Does the Surgery Completely Prevent Urinary Infections?

No, but it reduces infections caused by urine pressure or leakage. In some cases, the patient may need antibiotics for prevention or treatment.

Will the Bladder Remain Enlarged for Life?

Generally, yes, but some patients may need regular follow-ups. The bladder's storage capacity improves gradually after surgery.

Can I Return to Normal Life After the Surgery?

Yes, after recovery (usually 6–12 weeks), most daily activities can be resumed. It's important to follow the doctor’s instructions regarding catheter use and hygiene.

What Are the Long-Term Risks?

Bladder stones or recurrent infections.
Need for catheter use in some cases.
Rare complications such as urine leakage or intestinal problems if the intestine was used in surgery.

How Common is Bladder Augmentation Surgery?

Bladder augmentation surgeries are relatively rare. In 2009, healthcare providers performed around 595 surgeries worldwide.

How Long Does the Bladder Augmentation Surgery Last?

The successful effects of the surgery are permanent and last a lifetime.

How Long Does the Surgery Take?

Typically, the surgery lasts between 2 to 6 hours, depending on the condition and the type of procedure.

Benefits of Bladder Augmentation Surgery:

Increased Bladder Capacity: Allows the bladder to hold urine longer, reducing the need for frequent urination.
Reduced Nighttime and Sudden Urination: Helps improve sleep for those suffering from nocturnal or sudden incontinence.
Kidney Protection: In cases of small bladder or bladder pressure, bladder augmentation reduces pressure on the kidneys, preventing damage.
Improved Quality of Life: Reduces sudden urine leakage, enhancing comfort both mentally and socially.
Treats Chronic Urinary Issues: Helps with conditions like neurogenic bladder caused by spinal cord injuries or nerve diseases.

Types of Bladder Augmentation Procedures:

Enterocystoplasty (Using the Intestine):
- Description: The most common method, using a piece of the intestine (small intestine or colon) to increase the bladder’s size.
- Benefits: Significant bladder capacity increase, kidney protection from high urine pressure.
- Potential Complications: Recurrent infections, bladder stones, digestive or absorption issues.
Auto-augmentation (Using the Bladder Itself):
- Description: Expanding part of the bladder wall to create an internal "pocket" without using the intestine.
- Benefits: Less invasive surgery, fewer complications.
- Disadvantages: Less increase in capacity, not suitable for all cases.
Bioaugmentation (Using Engineered Cells):
- Description: Using the patient's own cells to create new bladder tissue in the lab and then implanting it.
- Benefits: Fewer complications related to using the intestine, fewer long-term issues.
- Disadvantages: A newer technology, not available in all hospitals, and high cost.

Stages of the Bladder Augmentation Procedure:

Preparation Before Surgery:
- Comprehensive assessment (blood tests, kidney function tests, ultrasound or X-ray).
- Bladder function and capacity evaluation.
- Sometimes, bowel cleaning if a part of the intestine is to be used.
- General anesthesia before the procedure.
Surgical Incision and Accessing the Bladder:
- A surgical incision in the abdomen to access the bladder.
- Identifying the part to be enlarged or augmented.
Preparing the Intestine (if Used):
- Selecting a piece of the small intestine or colon.
- Carefully separating it while preserving blood supply.
- Cleaning and preparing the segment to be used for bladder enlargement.

D. Bladder Augmentation Procedure

Creating an Opening in the Bladder Wall
- A cut is made in the bladder wall.
- The chosen part is stitched or an internal pouch is created (in the case of Auto-augmentation).
- Ensure the stitches are secure to prevent leakage.
Placing Urinary Drainage Tubes
- A urinary catheter is placed to drain urine during the initial days after surgery.
- Sometimes, an internal drainage tube from the intestines is used if part of the intestine is used in the procedure.
Closing the Abdomen and Follow-up
- The abdominal wall is stitched up.
- Kidney functions, urine output, and monitoring for any infections or leaks are carefully followed.
- The catheter may remain temporarily for up to two weeks or longer, depending on the case.

2. What Happens After Bladder Augmentation Surgery?

A. Early Recovery Period

Stay in the hospital for several days, depending on the case.
A urinary catheter is usually needed for about two weeks or as directed by the doctor.
Kidney functions and daily urine output are closely monitored.
Mild abdominal pain can be managed with pain relievers.

B. Changes in Urination

Gradual increase in bladder capacity.
Some patients may need to self-catheterize to fully empty the bladder.
Frequency of urination decreases, and sudden leakage may lessen or disappear.

C. Potential Risks or Complications

Urinary tract infections (UTIs) or bladder infections, especially in the first few weeks.
Bladder stones, especially if part of the intestine was used.
Digestive or absorption issues if the intestine was used.
Rarely, leaks from the stitch site that require surgical intervention.

D. Long-Term Follow-up

Periodic monitoring of kidney and bladder functions.
Regular tests to ensure no stones or infections are present.
Learning how to self-catheterize if needed.
Improved quality of life: Better sleep, increased confidence, and less frequent sudden urination.

3. Diagnosing the Need for Bladder Augmentation

A. Symptom Evaluation

Frequent or sudden urinary incontinence.
Recurrent nighttime urination.
Difficulty emptying the bladder or persistent pressure.
History of kidney problems or recurrent urinary tract infections.

B. Clinical Examination

Abdominal and pelvic examination.
Evaluation of bladder function and ability to hold urine.
Assessment of bladder size via ultrasound.

C. Laboratory Tests

Urinalysis: To detect infections or blood.
Blood tests: To check kidney function and calcium levels.

D. Imaging Studies

Ultrasound to evaluate bladder and kidney size.
Dye-based imaging (IVP or CT scan) to assess the urinary tract.
Cystogram or VCUG to visualize the bladder during filling and emptying.

E. Urodynamic Studies

Measures the bladder's ability to store and empty urine.
Determines pressure within the bladder to protect kidney function.

F. Comprehensive Evaluation Before Surgery

The doctor determines the suitability of the surgery based on:
- Severity of symptoms
- Current bladder function
- Kidney condition and potential risks.

4. Recovery After Bladder Augmentation Surgery

A. Hospital Stay

Typically 5–10 days to monitor urine output, kidney function, and check for any infections or complications.
A urinary catheter is likely to stay in place during this period.

B. Early Recovery at Home (2–4 Weeks)

Mild abdominal pain from the surgery site.
Possible use of a self-catheter to empty the bladder if necessary.
Rest and avoid heavy lifting.

C. Full Recovery (6–12 Weeks)

The bladder's capacity improves gradually.
Urination becomes more regular and less frequent.
Return to normal daily activities.

D. Long-Term Follow-up

Regular monitoring for infections or stones.
Kidney and bladder function assessment.
Guidance on self-catheterization if required.

5. Risks and Complications of Bladder Augmentation Surgery

A. Urinary-Related Issues

Urinary tract infections (UTIs): Common, especially in the first few weeks.
Bladder stones: May develop over time, especially with intestinal use.
Difficulty fully emptying the bladder: Some patients may need self-catheterization.

B. Bladder-Related Problems

Leakage from the stitch site: Rare but possible, requiring additional surgery.
Weak bladder muscles or recurrence of incontinence in some cases.

C. Intestinal-Related Problems

Digestive or absorption issues: Reduced absorption of certain nutrients, particularly if part of the intestine was used.
Inflammation or obstruction of the intestine: Rare but can occur.

D. General Surgery Complications

Post-surgery pain: Typically managed with pain relievers.
Blood clots or bleeding: Rare, but present in any major surgery.
Anesthesia complications: As with any major surgery requiring general anesthesia.

6. Types of Bladder Augmentation and Treatment for Its Disorders

1. Enterocystoplasty (Using the Intestine)

Description: A piece of the small intestine or colon is stitched to the bladder to increase its size.
Indications: Small or malformed bladder, inability to hold urine, protecting kidneys from high urinary pressure.
Benefits: Significant capacity increase, better urinary control, kidney protection.
Risks/Drawbacks: Recurrent infections, bladder stones, digestive problems, occasional need for self-catheterization.

2. Auto-augmentation (Using the Bladder Itself)

Description: Expanding part of the bladder wall to create an internal “pouch” without using the intestine.
Indications: Patients needing a small increase in bladder capacity or those with issues using the intestine.
Benefits: Less invasive surgery, fewer complications.
Drawbacks: Less capacity increase, may not fully protect kidneys in some cases.

3. Tissue Engineering / Bioaugmentation

Description: Using the patient’s own cells to create new bladder tissue in the lab, then implanting it.
Indications: Patients who cannot use the intestine or bladder itself.
Benefits: Fewer complications related to using the intestine, fewer long-term issues.
Drawbacks: New technology, not widely available, high cost.

4. Rare Techniques (Using Other Tissues)

Description: Using skin or other tissues from the body to augment the bladder.
Indications: Rare cases where other methods cannot be used.
Benefits: Alternative when other methods are not feasible.
Drawbacks: Less effective, more complications, rarely used.

7. Medications Before or After Bladder Augmentation

A. Medications for Overactive Bladder

Examples: Oxybutynin or Tolterodine.
These reduce frequent urination and incontinence but do not increase bladder size.

B. Medications for Bladder Muscle Spasms

Example: Mirabegron (Beta-3 agonist).
Useful for neurogenic bladder to reduce spasms.

C. Anti-inflammatory or Antibiotics

Used for prevention or treatment of infections before or after surgery.

D. Post-Operative Medications

Pain relievers to manage surgical pain.
Laxatives if part of the intestine is used to prevent constipation.

Important Notes

Medications cannot replace bladder augmentation surgery.
Their goal is to improve symptoms and manage complications before or after surgery.
The doctor will determine the type and dosage based on the patient’s bladder and kidney condition.