Introduction
The bladder is a balloon-shaped organ that holds urine until it is excreted out of the body. It is located in the lower abdomen. The bladder remains relaxed while it is empty. The brain sends signals to the brain when the bladder is full, and the urge to urinate is activated. The brain sends signals to the bladder to contract, and the urine is passed out of the body through the urethra. The sphincter muscles in the urethra help to hold the urine till the toilet is reached. The sphincter opens as the bladder contracts.
What Is Bladder Augmentation Surgery?
In some people, the bladder capacity is small that it cannot hold the amount of urine produced by the kidneys. On the other hand, the ability of the bladder to stretch might be lost in some people, making it impossible to hold more urine. This can lead to an increase in pressure inside the bladder. This often prevents proper or complete drainage of the urine. The increased pressure can sometimes push the urine back to the kidneys (reflux). These conditions can cause urinary incontinence, urinary tract infections, or kidney damage. Bladder augmentation is a surgical procedure to reduce the pressure in the bladder by making it bigger.
What Are the Indications for Bladder Augmentation Surgery?
Bladder augmentation is a surgical procedure with high success rates. It is especially beneficial in neurogenic and non-neurogenic bladder dysfunction, where conservative management, pharmacological methods, and minimally invasive treatments could not yield successful results. Indications for bladder augmentation surgery can include the following;
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Detrusor Hyperactivity: People with detrusor hyperactivity (involuntary contractions of the detrusor muscle causing urinary incontinence). Conservative management and medications are tried initially. When these methods are less beneficial or have become a failure, a bladder augmentation procedure is advised.
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Refractory Neurogenic Bladder Dysfunction: In refractory neurogenic bladder dysfunction, a hyperactive bladder can cause urinary incontinence. Urinary incontinence is a condition where a person leaks urine accidentally.
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Infective and Inflammatory Bladder Disorders: Bladder augmentation is done in cases of infective bladder disorders. These usually cause a bladder with low capacity or poor compliant bladder.
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Spasticity: Some diseases might cause the bladder muscles to become stiff, which can be seen as urge-related leakage, an increase in the frequency of urination, or pain in the bladder.
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Post Radiotherapy Cystitis: Radiotherapy cystitis is inflammation and cellular destruction resulting from radiation therapy.
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Schistosomiasis: It is a parasitic infection caused by blood flukes or trematode worms.
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Interstitial Cystitis: It is a chronic condition causing increased pressure in the bladder and bladder pain and is sometimes associated with pain in the pelvis.
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Loss of Bladder Capacity: It is done in some conditions where the bladder loses the capacity to hold urine.
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Neurogenic Bladder: It is usually associated with neurogenic conditions like problems related to the brain, spinal cord or nerves controlling the bladder.
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Spina Bifida: It is a neural tube defect affecting the spinal cord. It can cause a spectrum of symptoms, but mainly seen as primary functional deficits are lower limb paralysis and sensory loss, bladder and bowel dysfunction, and cognitive dysfunction.
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Posterior Urethral Valves: It usually causes bladder obstruction in males.
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Prune Belly Syndrome: It is also called Eagle-Barrett syndrome. It is a congenital disorder that is rare. It usually occurs in males and is characterized by the absence of abdominal muscles, urological abnormalities, and Bilateral cryptorchidism.
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Bladder Exstrophy: It is a rare condition that occurs rarely and is usually seen in the early life of the fetus. As the bladder develops, the abdominal walls do not fuse completely, exposing the bladder.
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Cloacal Exstrophy: It is a condition where some internal organs in the lower abdominal area are exposed. In some conditions, these organs might not have developed entirely and can include the lower parts of the reproductive, urinary, and intestinal tracts.
What Are the Contra-Indications for Bladder Augmentation Surgery?
The contra-indications of a ladder augmentation surgery an include
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Unable to Perform Life-long Intermittent Catheterization: Patients unwilling for or unable to undergo lifelong catheterization intermittently should not opt for this procedure, as the surgery might equity intermittent requirement for catheterization.
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Bladder tumors.
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Severe Radiation Cystitis: Radiation cystitis is inflammation and cellular destruction due to radiation therapy. Bladder augmentation should be avoided in severe cases.
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Severe Renal Insufficiency: Bladder augmentation should be avoided in cases where e functions of the kidneys are compromised or do not function properly.
How Is Bladder Augmentation Surgery Done?
Before the surgery, a series of tests would be de to check if the patient is fit for the procedure. They can include;
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Physical examination.
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Blood tests.
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X-rays
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Cystoscopy (A procedure to examine the bladder).
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Urodynamic testing (A procedure that is done to explore the lower abdomen or the urinary tract).
The procedure is done with general anesthesia. The area will be prepared by shaving the area and sanitizing the area with an antiseptic to kill any bacteria present. The procedure may be done through a big incision or several small holes. Either way, the bladder will be opened, upland a patch of bowel will open up. This helps to make the urinary reservoir a mixture of the bladder and intestine. Sometimes, a small channel will be made to allow the passage of the catheter into the new bladder to drain it. This channel is called Mitrofanoff or catheterize able channel. There will be two to three tubes in the abdomen after the surgery. This will help keep the bladder drained as it heals and permits lavage or "washing" of the mucous out of your bladder.
Conclusion
Bladder augmentation was earlier used in treating low capacity, poorly compliant, or overactive bladder. After a bladder augmentation, the bladder will increase in size and capacity. As a result, the bladder's pressure and urination frequency reduces. But there can be other risks or complications associated. The intestines continue to secrete mucous, which may clog the catheter or affect the urine flow. It can even cause the bladder to tear. A high frequency of urinary tract infections may be seen after the procedure. Advancements in the procedure include laparoscopic surgery and robotic augmentation cystoplasty.
