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    Bladder augmentation

    Is there anyone out there who would be willing to discuss their experience with a bladder augmentation? It looks like that may be the only solution regarding leakage for my 22yr old son in order to regain some independence and freedom. Please.....we have tried all the meds and botox 3 times with no good results... desperate
    Could you message me privately so we can chat...thanks!!!!

    #2
    Since the advent of bladder Botox, we do many fewer augmentation surgeries, but for someone who has failed both multiple oral anticholenergics, bladder Ditropan instillations, and Botox, it may be the best way to go.

    It is a BIG surgery, and he will feel like he was hit by a truck for the first 7-10 days post-op. It requires a bowel clean-out prior to surgery. Usually the segment of large bowel used is 10 inches or so, so one of the results it a total disruption of your bowel routine for up to 6 weeks post op. Accidents are common during that period. It is common to have a post-operative ileus for up to 7 days during which time an NG tube to suction must be used, and no food is allowed orally. If it is prolonged, TPN should be considered to aid in surgical healing. There may be as many as 3 catheters in place (two ureteral, one urethral) while healing takes place, and drains may also be in place (JP drains usually). The surgery itself can be fairly long, so care must be taken to properly pad the OR table to prevent intra-operative pressure ulcers, and a specialty pressure reducing bed or mattress should be used on the inpatient unit.

    Once the indwelling catheters are removed, intermittent cath must be done initially as often as every 2 hours to avoid any distention of the bladder that could stress the internal stitches. This is gradually increased over time. Generally the person will have a post-operative acidosis due to absorption of H+ ions from the urine through the intestinal segment, so he may need to take sodium bicarbonate tablets for a year or more. Generally the bladder will also require irrigation 1-2X daily at the end of catheterizations to remove any mucous created by the bowel.

    Sometimes it is combined with a Mitrofanoff procedure, but these are done much more in women than in men.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      Bladder Augmentation

      My doctor recommmended bladder augmentation for my problem (frequent urge to void due to small bladder-380ml). I have tried oral medications, interstim implant, botox, but not ditropan instillation. After reading other patients who suffer diarrhea after the bladder augmentation procedure, I'm worried that i will have additional problem to worry about. My doctor mentioned he will take the patch from my stomach. What is the difference (advantage/disadvantage) from taking it from small intestine, large intestine, or bowel?

      Thanks,
      MannyE

      Comment


        #4
        I have only seen augmentations done with large bowel and stomach. Small bowel is...too small. It is possible to use stomach, although a much more difficult surgery due to the greated distance that the tissue and attached blood vessels must be moved to reach the bladder. The main advantage of stomach is that you will have less (but not necessarily) diarrhea, and less problems with metabolic acidosis to deal with than if large bowel is used. Mucous can still be a problem with both.

        Even if large bowel is used, rarely do bowel problems last more than 4-6 weeks post-operatively.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          I was injured 8/87 and had my surgery 12/02. I fully agree it is a rough surgery to recover from. Rough physically and mentally. HOWEVER it was the BEST decision i ever made!! love love love the end result. would do it over again in a heartbeat and wonder why i even debated it so long. Ask me any questions.

          Comment


            #6
            i had this done in 2006 and it is way different than what KLD described. best.decision.ever!!!!!! feel free to pm me if you'd like!

            3 days before i started my bowel prep with fasting, mag citrate and other stool softeners. day before surgery i had to drink fleets phosphosoda til i was cleaned out. THAT was the hardest part as i wanted to vomit and it tasted so bad!

            my dr used bowel to expand my bladder and my appendix as a conduit from my belly button into the bladder. my surgery was ~7hrs and afterwards it felt like i was hit by a mac truck + got into a fight with bruce lee and lost. badly. the worst part was the mucus formed from the ng tube and i felt like i was choking. suction was my friend. the severe pain only lasted 3 days. i wasnt allowed to eat/drink for 2 weeks. then it was slowly introduced. once i passed gas i was sent home with an indwelling cath. my scar is 22cm long and i accidentally ripped out the indwelling prematurely while climbing onto the toilet from the floor. i was literally back to my routine at the time of climbing up and down the stairs on my belly as soon as i got home. once the indwelling was gone i cathed every 4 hours and had no issues.

            i still, unfortunately, leak via my urethra. sometimes it is bad but most times it is a few drops - half dollar sized. i've been tested with every test they know and no one knows why as everything has healed perfectly.

            despite this i wouldnt change it for the world! i can go to friends' houses with no worries on if i can use the bathroom. same with long trips! all i need is a bottle and i am good to go. so please feel free to ask!
            "Smells like death in a bucket of chicken!"
            http://www.elportavoz.com/

            Comment


              #7
              crypticgimp
              Senior Member

              Join Date: Apr 2010
              Location: Rochester, NY
              Posts: 575


              i had this done in 2006 and it is way different than what KLD described. best.decision.ever!!!!!! feel free to pm me if you'd like!

              3 days before i started my bowel prep with fasting, mag citrate and other stool softeners. day before surgery i had to drink fleets phosphosoda til i was cleaned out. THAT was the hardest part as i wanted to vomit and it tasted so bad!

              my dr used bowel to expand my bladder and my appendix as a conduit from my belly button into the bladder. my surgery was ~7hrs and afterwards it felt like i was hit by a mac truck + got into a fight with bruce lee and lost. badly. the worst part was the mucus formed from the ng tube and i felt like i was choking. suction was my friend. the severe pain only lasted 3 days. i wasnt allowed to eat/drink for 2 weeks. then it was slowly introduced. once i passed gas i was sent home with an indwelling cath. my scar is 22cm long and i accidentally ripped out the indwelling prematurely while climbing onto the toilet from the floor. i was literally back to my routine at the time of climbing up and down the stairs on my belly as soon as i got home. once the indwelling was gone i cathed every 4 hours and had no issues.

              i still, unfortunately, leak via my urethra. sometimes it is bad but most times it is a few drops - half dollar sized. i've been tested with every test they know and no one knows why as everything has healed perfectly.

              despite this i wouldnt change it for the world! i can go to friends' houses with no worries on if i can use the bathroom. same with long trips! all i need is a bottle and i am good to go. so please feel free to ask!
              __________________
              "Smells like death in a bucket of chicken!"
              www.elportavoz.com
              SCI-Nurse, thank you very much for the answer to my question. I guess each doctor has his/her own preferences, as I have read articles that the intestines are also used. I'm afraid of any possible adverse effect of reduction in size of my bladder or bowel. I'm already paranoid because my bladder problem now was caused by the cut my urologist had to make to clear my urethra of infection resulting from a Greenlight laser prostate surgery.

              Crypticgimp,

              Thanks for sharing your experience. I am still waiting for confirmation of my surgery at the end of this month at USC Hospital and your input gets me better prepared on what to expect.

              I am just disappointed that leaks could still be a problem. Does the bad leak happen even if your bladder is not too full? How bad is bad?

              Any change in your vowel movement ?

              Thanks,
              MannyE

              Comment


                #8
                Originally posted by SCI-Nurse View Post
                I have only seen augmentations done with large bowel and stomach. Small bowel is...too small. It is possible to use stomach, although a much more difficult surgery due to the greated distance that the tissue and attached blood vessels must be moved to reach the bladder. The main advantage of stomach is that you will have less (but not necessarily) diarrhea, and less problems with metabolic acidosis to deal with than if large bowel is used. Mucous can still be a problem with both.

                Even if large bowel is used, rarely do bowel problems last more than 4-6 weeks post-operatively.

                (KLD)
                SCI Nurse,

                Would my frequent urge to void disappear once I have the bladder augmentation? Could I still void the natural way if I try? Is leaking problem, which I don't have now, a possible consequence? Is my 380 ml. bladder capacity really too small?

                Thanks,
                MannyE

                Comment


                  #9
                  Originally posted by MannyE View Post
                  crypticgimp
                  Senior Member

                  Join Date: Apr 2010
                  Location: Rochester, NY
                  Posts: 575


                  i had this done in 2006 and it is way different than what KLD described. best.decision.ever!!!!!! feel free to pm me if you'd like!

                  3 days before i started my bowel prep with fasting, mag citrate and other stool softeners. day before surgery i had to drink fleets phosphosoda til i was cleaned out. THAT was the hardest part as i wanted to vomit and it tasted so bad!

                  my dr used bowel to expand my bladder and my appendix as a conduit from my belly button into the bladder. my surgery was ~7hrs and afterwards it felt like i was hit by a mac truck + got into a fight with bruce lee and lost. badly. the worst part was the mucus formed from the ng tube and i felt like i was choking. suction was my friend. the severe pain only lasted 3 days. i wasnt allowed to eat/drink for 2 weeks. then it was slowly introduced. once i passed gas i was sent home with an indwelling cath. my scar is 22cm long and i accidentally ripped out the indwelling prematurely while climbing onto the toilet from the floor. i was literally back to my routine at the time of climbing up and down the stairs on my belly as soon as i got home. once the indwelling was gone i cathed every 4 hours and had no issues.

                  i still, unfortunately, leak via my urethra. sometimes it is bad but most times it is a few drops - half dollar sized. i've been tested with every test they know and no one knows why as everything has healed perfectly.

                  despite this i wouldnt change it for the world! i can go to friends' houses with no worries on if i can use the bathroom. same with long trips! all i need is a bottle and i am good to go. so please feel free to ask!
                  __________________
                  "Smells like death in a bucket of chicken!"
                  www.elportavoz.com
                  SCI-Nurse, thank you very much for the answer to my question. I guess each doctor has his/her own preferences, as I have read articles that the intestines are also used. I'm afraid of any possible adverse effect of reduction in size of my bladder or bowel. I'm already paranoid because my bladder problem now was caused by the cut my urologist had to make to clear my urethra of infection resulting from a Greenlight laser prostate surgery.

                  Crypticgimp,

                  Thanks for sharing your experience. I am still waiting for confirmation of my surgery at the end of this month at USC Hospital and your input gets me better prepared on what to expect.

                  I am just disappointed that leaks could still be a problem. Does the bad leak happen even if your bladder is not too full? How bad is bad?

                  Any change in your vowel movement ?

                  Thanks,
                  MannyE
                  i think i answered this in pm but i will do so again here: the amount of leakage depends. sometimes just a quarter sized to sheets being soaked. no discernable pattern has been established and i've been thru all the tests, all of which say that things are normal. lately i've been pretty dry at least 4 days out of the week. nothing has changed with my bowels at all.
                  "Smells like death in a bucket of chicken!"
                  http://www.elportavoz.com/

                  Comment


                    #10
                    Originally posted by MannyE View Post
                    SCI Nurse,
                    Would my frequent urge to void disappear once I have the bladder augmentation? Could I still void the natural way if I try?
                    I assume you have a spinal cord injury and a neurogenic bladder or you would not be using this forum or anticipating an augmentation. So no, you cannot void "normally" (and don't do that now). If you mean can you still reflex void, no, it is unlikely that you would be able to do this. An augmentation is designed to increase capacity and decrease pressures for those who plan to do intermittent cath.

                    Originally posted by MannyE View Post
                    Is leaking problem, which I don't have now, a possible consequence?
                    If you don't leak now, then it is very unlikely that you would leak after an augmentation unless you fail to cath on time.

                    Originally posted by MannyE View Post
                    Is my 380 ml. bladder capacity really too small?
                    Since you say you don't leak, I assume that is the amount where your bladder pressures shoot up to too high of a number (well over 40). Capacity is determined either by the point at which you leak, or the point at which you bladder has unsafe high pressures. Yes, you should have a capacity of more like 400-450 cc.

                    (KLD)
                    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                    Comment


                      #11
                      I don't have a spinal chord injury. I am a healthy 64-year old man whose only problem is overactive bladder. I did have a urologist cut my bladder to treat a urethra infection after I had a prostate laser procedure about six years ago. I had recurrent scarring/constricture problem ever since eventually causing me to have frequent urge to void. Oral medications, DMSO, and Interstim implant did not work. I had botox treatment last April which resulted in my having to self cath every 3-4 hours to void. Since I am having self cath difficulty and recurrent constricture problem my urologists recommend bladder augmentation. I am currently scheduled for the surgery on January. I am still not sure that I want to undergo this procedure and I am desperately seeking as much information about this procedure, results, and maybe another option.

                      I just discovered this website recently amd i'm very glad I did.

                      I would appreciate any other input, comments, or advice.

                      Thanks,
                      MannyE

                      Comment


                        #12
                        Just to clarify, an augmentation ONLY makes the bladder larger and decreases pressure inside the bladder. It does nothing to the urethra, so would not do anything for urethral strictures. If that is a problem, you probably actually need a Mitrofanoff procedure instead (or in addition), but this would also require that you do intermittent catheterization as your method of bladder emptying.

                        (KLD)
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment


                          #13
                          I believe I will have the Mitrofanoff (same as cath through my belly?) and with my small size bladder (300ml functional) and difficulty with urethral cath, I guess it does make sense that I undergo bladder augmentation as it will stretch the time between caths. Like one of my doctors said, "if I will have a bladder surgery, might as well make my bladder bigger."

                          I would like to thank you and everybody for answering my questions and sharing their experiences. I am better prepared now to undergo the surgery. Any additional information, recommendations, etc. will always be welcome. Hopefully I could return the favor in the future.

                          MannyE

                          Comment


                            #14
                            Leakage after surgery???

                            Ten days from bladder augmentation and stoma surgery, and a week of hell in the hospital seemed all was going to plan...and then today we had 2 episodes of leakage through the penis.
                            Please someone tell me this is temporary and that if could be from a uti or something..I will not forgive myself if I let my son go through this hell and mutilation of his body if the procedure was a failure....HELP...any words of wisdom...losing all hope....

                            Comment


                              #15
                              I had some leaks a few weeks after I had mine done, usually at night in bed while I slept.
                              Only happened twice, 2 yrs post and I never leak ( my sphincter was shot before op anyway) and I've had 900mls in there, give it some time, long way till stabilisation yet.
                              Good luck!

                              Comment

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