Augmentation Cystoplasty: Causes, Diagnosis, and Treatment

What Is Augmentation Cystoplasty?

Augmentation cystoplasty or bladder augmentation is a procedure that aims to enlarge the urinary bladder. This surgery is specifically indicated for patients who have difficulty passing urine due to underlying medical conditions. It has traditionally been used to manage low-capacity, overactive, or poorly compliant urinary bladder. Augmentation cystoplasty provides a safe and functional reservoir that prevents urinary incontinence and upper urinary tract infections. Nowadays, augmentation cystoplasty remains the treatment of choice in pediatric and kidney transplant procedures. This is because botulinum toxin and sacral neuromodulation techniques have replaced augmentation cystoplasty surgeries.

What Are Some of the Causes of Bladder Dysfunction?

There are several causes of bladder dysfunction, including neuropathic and non-neuropathic causes. The neuropathic causes of bladder dysfunction are listed below:

• Injury of the spinal cord.

• Multiple sclerosis (a chronic condition that damages the entire nervous system).

• Myelodysplasia (a group of disorders in which the red blood cells are poorly formed or immature).

The non-neuropathic causes of bladder dysfunction are listed below:

1. Instability of the detrusor muscles (the muscles present in the wall of the bladder).

2. Chronic cystitis (long-standing inflammation of the urinary bladder).

3. Interstitial cystitis (a chronic condition causing bladder pain, pressure, and pelvic pain).

4. Radiation cystitis.

5. Dialysis for prolonged periods.

What Are the Indications of Augmentation Cystoplasty?

Augmentation cystoplasty is specifically performed in patients with a marked reduction in bladder capacity or who have trouble urinating due to several underlying medical conditions. The indications of augmentation cystoplasty are listed below:

• Urinary incontinence or the leakage of urine.

• Bladder muscles are not working properly.

• The bladder fails to stretch, which increases the pressure on the kidneys and the bladder, leading to a condition known as vesicoureteral reflux.

• Stiffness or spasticity of the bladder.

• Shrinkage of the bladder due to radiation therapy and diseases.

In some cases, augmentation cystoplasty is usually done after the patient has performed self-catheterization for a prolonged period. It is a procedure in which the patient inserts a tube known as the catheter into the urinary bladder through the urethra to facilitate urine drainage.

What Are the Contraindications of Augmentation Cystoplasty?

Augmentation cystoplasty is contraindicated for patients who are unwilling or unable to perform life-long catheterization. This is because catheterization will be required after augmentation cystoplasty. In addition to catheterization, people suffering from inflammatory bowel disease, renal insufficiency, bladder cancer, and radiation cystitis must refrain from undergoing augmentation cystoplasty. Elderly individuals and people with poor life expectancy must consider alternative treatment options for augmentation cystoplasty.

How Should the Patient Prepare for the Procedure?

Before undergoing augmentation cystoplasty, the patient must undergo the following tests:

• Physical Examination - The doctor will evaluate the patient for the physical signs of bladder dysfunction. After the physical examinations have revelated that the patient is clinically fit for the surgery, the doctor will order imaging and laboratory tests to rule out other abnormalities.

• Urinalysis - It is a simple procedure in which the patient collects the urine sample in a sterile bag or a container. The urine sample is then examined in the laboratory under a microscope.

• Urine Culture Test - It is a procedure in which the urine sample collected from the patient is left unattended in the laboratory for a few days. The laboratory technician evaluates the rate of bacterial growth in the urine sample and prepares a report.

• Renal Ultrasound - It is a simple imaging procedure in which the patient is laid on the X-ray table. The doctor moves a device known as a transducer over the patient’s abdomen to obtain images of the urinary tract.

• Cystoscopy - Cystoscopy is a minimally invasive procedure in which a telescope-like instrument known as the cystoscope is inserted into the urinary tract through the urethra. It helps the doctor to diagnose and treat urologic problems simultaneously.

How Is the Procedure of Augmentation Cystoplasty Done?

Augmentation cystoplasty is a type of abdominal surgery in which the surgeon makes an incision in the patient’s abdomen to reach the urinary bladder. After making a cut in the abdomen, the doctor incises the bladder and prepares it for enlargement. Next, the surgeon removes a portion of the small or large intestine, detublarizes the link of the bowel, and attaches it to the top of the urinary bladder. The urinary bladder and the bowel are stitched together to enlarge the bladder.

What Happens After the Augmentation Cystoplasty Procedure?

After the procedure is complete, the patient stays in the hospital for five to seven days. The following things usually happen after the procedure is complete:

• The patient will be able to eat or drink only a few days after the surgery. Instead, the patient will receive fluids through the intravenous line.

• When the patient is in the hospital, the patient will have two or more tubes attached to the abdomen and the urinary bladder.

• The nurse will instruct the patient on how to take care of these tubes and eliminate the mucus from the bladder after the surgery.

• As the urinary bladder is in contact with the bowel, the patient is likely to notice mucus in the urine.

• The patient must irrigate the mucus every morning throughout their life.

• If the patient fails to irrigate the mucus, it forms stones, and the patient will need additional surgeries to remove them.

• Retained mucus will also increase the risk of urinary tract infections.

• The patient will be recalled for follow-up after two to three weeks, and the doctor will order a radiology test.

• This test helps the patient ensure that the bladder is large and is not leaking. If the doctor feels that the test reports are alright, the patient will be instructed to undergo irrigation and self-catheterization.

• The patient can resume daily activities and return to work six weeks after the surgery.

• The urinary bladder is a muscular structure, so the patient will be unable to empty the bladder immediately after the surgery.

• The patient will have to remain on self-catheterization for the entire life.

• Sometimes, the doctor might create a new channel during the augmentation cystoplasty procedure so that the patient can pass the catheter through the belly button.

• The patient will be instructed about using catheters three weeks after the surgery.

Conclusion:

Augmentation cystoplasty is a surgical procedure done to enlarge the urinary bladder. This surgery is a boon for those having difficulty passing urine due to certain medical conditions. The biggest advantage of the procedure is that it hardly has any complications. Hence, it can be safely carried out, and the patients do not have any surgical trauma at a later stage. So, patients with difficulty passing urine should consult a urologist at the earliest to learn more about the augmentation cystoplasty procedure.