Augmentation Cystoplasty

Augmentation Cystoplasty (Enlargement of the bladder using a segment of bowel)

Q 1. What does the procedure involve?

A. This involves enlargement of the bladder through a lower abdominal incision by taking an isolated segment of bowel, and forming this into a patch that is sewn into an opening made in the bladder. It is also known as ileo-cystoplasty or clam cystoplasty.

Q 2. What are the alternatives to this procedure?

• Observation
• Bladder training
• Pelvic floor exercises
• Drugs
• Injections into the bladder (BOTOX)
• Urinary diversion
• Sacral nerve stimulation.

Q 3. What should I expect before the procedure?

A. You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc
• You are taking prescription drugs like-
  • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
  • Anti-epileptics like phenytoin, valproate etc

Q 4. What happens during the procedure?

A. Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post operatively.
Through an incision in your lower abdomen, the bladder will be opened and spilt almost in two. The two halves will then be joined together using a patch fashioned from an isolated segment of bowel and the ends of the bowel from where the segment has been taken will be re-joined.

Q 5. What happens immediately after the procedure?

A. You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home.

Two catheters will be placed in the bladder for about two to three weeks, one via the urethra and one (suprapubic catheter) via a small incision in the skin over the bladder. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach.

After your operation, you may be in the intensive care unit or the special recovery area of the operating theatre before returning to the ward.

You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible.

Q 6. What is the duration of stay?

A. The average duration of stay is 5 to 7 days.

Q 7. What are the side effects/complications?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

• Infection or hernia of the incision requiring further treatment
• Diarrhoea/ vitamin deficiency/ constipation due to shortened bowel, requiring treatment
• Bowel and urine leakage from the anastomosis requiring re-operation
• Scarring of the bowel or ureters requiring further surgery
• Recurrent urinary infections, requiring long-term antibiotic treatment
• Temporary or long-term tendency for the blood to be more acidic than normal, requiring temporary or long-term medication
• Need to self-catheterise because the enlarged bladder will be unlikely to empty fully after the procedure
• Decreased kidney function with time
• Passing mucus in the urine which can cause intermittent blockage of the urinary stream

Occasional (between one in 10 and one in 50)

• Blood loss requiring repeat surgery
• Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)

Rare (less than one in 50)

• Tumour formation at the site of the join between the bowel patch and the bladder
• Follow-up telescopic examinations of the bladder under local anaesthetic will begin at between 5 and 10 years after surgery to check for this possibility

Q 8. What should I expect when I get home?

A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.

You will require painkillers at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile.

You may go home with one or both catheters still in place, and have a planned return to hospital for these to be removed. If so, you or your carers will be taught how to look after the catheters and the drainage systems for them.
You will need a second visit to hospital for an x-ray test on the bladder at around three weeks (cystogram). If this is normal and shows no bladder leak, your catheters will be removed in hospital.

You should avoid driving for at least six weeks, and it may be longer before this is possible.

If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity.

Heavy lifting should be avoided for six weeks.

Sexual intercourse should be avoided for at least a month.

You may see blood in the urine or vaginal discharge for up to a month after surgery.

Q 9. What else should I look out for?

A. If you go home with catheters, you or your carers should check regularly to ensure that urine is draining via the catheters, which confirms that the catheters have not blocked. If the catheters are both blocked this could put pressure on the suture line in the bladder, and so the catheters would need to be flushed and unblocked very promptly.

If you develop fever or vomiting (especially if associated with unexpected pain in your abdomen), temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.

Q 10. What are other important points?

A. A follow up outpatient appointment will normally be arranged six to eight weeks after the operation to assess the outcome.

It will take at least six months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.