Augmentation Cystoplasty

Augmentation cystoplasty is a surgery aimed to enlarge the urinary bladder.

Augmentation cystoplasty is an operation where a segment of bowel is isolated from the rest of the bowel and sewn as a patch onto the bladder to increase the size of the bladder. This involves enlarging the bladder by incising the bladder into half and placing a part of the bowels / intestine to enlarge the bladder. An enlarged bladder increases its capacity of holding on to urine much longer than normal.

This surgery is done in adults and children who do not have adequate bladder capacity, have a small contracted bladder or has a poorly compliant bladder (stiff bladder).

Augmentation cystoplasty is usually advised in the later stages of the disease management when there is failure to manage a bladder which is high pressure and poses a risk of kidney impairment or failure, as well as in certain conditions when urinary leakage cannot be controlled by medications. This will require a procedure to enlarge the bladder so as to allow the urine to be stored in the bladder for a longer period of time.

The aim of augmentation cystoplasty is:

• To increase the amount of urine the bladder can hold so patients need not go to the toilet as often.
• To stop involuntary bladder contractions which are causing urge incontinence.
• To lower the pressure at which the bladder stores urine when there is high bladder pressures so as to prevent the risk of causing kidney damage which may occur as a result of back-pressure from the bladder urine.

The conditions where augmentation cystoplasty may be indicated include:

• Certain conditions of urinary incontinence (leaking of urine) where the bladder cannot hold the urine long enough, and the patient invariably expels it out before the bladder is full enough for natural voiding.
• The bladder is very poorly compliant (spasticity or stiffness of the bladder) and not working properly. This results in high pressures in the bladder and may cause back-pressure up to the kidneys (reflux), which can cause kidney infections and damage the kidneys. This is usually seen in neurogenic bladders as in spinal injuries with hypertonic bladders.
• Shrinking of the bladder caused by treatments (as in radiation therapy) or diseases (e.g., tuberculosis of the bladder, ketamine-induced cystitis, severe interstitial cystitis and spinal cord injuries).

Augmentation cystoplasty is usually performed after a patient has been performing self-catheterization for some time and has failed medications. Self-catheterization is a procedure in which the patient regularly inserts a catheter (a thin, hollow tube) through his or her urethra (the tube through which urine comes out of the body) in order to drain urine. It is usually done when other treatments such as anticholinergic medication and intermittent self catheterization has failed.

Augmentation cystoplasty may not be suitable for:

• Patients who are unable to self-catheterize.
• Some patients with severe kidney failure.
• Patients who produce excessive volumes of urine which would mean they would have to catheterize too frequently to manage.
• Patients who produce extremely small volumes of urine.
• Patients with liver failure.
• Patients with bowel disease or who have had large volumes of bowel removed.
• Some patients who have had radiotherapy to their bladder and bowel.

The small bowel is isolated