What Is Bladder Augmentation?
Bladder augmentation is increasing the size of the bladder, usually with a patch of bowel. This allows patients to store a lot of urine in their bladder. It is usually used for patients that have neurologic injury or disease that has caused the bladder to shrink and frequently spasm leading to leakage of urine.
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How Does This Help Incontinence?
Most neurologic disease causes the bladder to shrink and also to spasm. The low volume and high pressure of the spasms causes urine to leak through the sphincter muscles. Often the sphincter muscles are very strong, but the bladder pressure overpowers them and leakage results. When the bladder volume is increased, the bladder can hold much more volume and this eliminates the spasms and the leakage.
When Would You Get Bladder Augmentation?
The typical reasons that your surgeon might recommend this surgery are the following:
- When the bladder becomes very small from problems like spinal cord injury
- When patients have physical limitations and cannot catheterize their urethra.
A common situation like this is a woman with paraplegia that has to move out of her wheelchair in order to catheterize. This can be very difficult and limits a patient’s ability to travel and participate in life. In this situation the bladder is usually increased in size, and at the same time a channel of small bowel is created that travels from the top of the bladder to the belly button (umbilicus). Then the patient can just lift up the lower portion of their shirt and pass the catheter from the belly button down to the bladder and drain out the bladder without changing positions.
Another common scenario is in a patient with quadriplegia who has difficulty with passage of a catheter down the urethra. In order to catheterize, a patient must have good enough hand function to undue their zipper and pull their pants down to access the penis or the vagina. This combined with the difficulty of finding or passing the catheter down the urethra can be very challenging for someone with limited strength and hand function.
When a catheterizable channel is brought up to the belly button, catheterization is much simpler and most quadriplegic patients that can write and pick up a pencil from a table can successfully catheterize these types of channels. A catheterizable channel can allow patients to be free of permanent catheters, like a Foley or suprapubic catheter, and successful do intermittent catheterization.
What Are the Types of Catheterizable Channels?
A catheterizable channel is a bowel tube made from appendix or small bowel that comes up to skin of the abdomen, often in the base of the belly button, and connects to the bladder. If patients have trouble with catheterizing their urethra, these channels can help them successfully remain on self-catheterization rather than going to a permanent catheter.
There are a variety of ways of making these channels depending upon whether patients need to have the bladder expanded or just need to have the channel made for ease of catheterization.
In this surgery the bladder volume is increased with a U of small bowel that is openedand made into a rectangle. The rectangle is sewn to the bladder and increases its volume dramatically. In this surgery a separate catheterization channel is not created and patients still catheterize their urethra. The procedure is called cutaneous catheterizable ileocecocytoplasty.