Bladder augmentation surgery is a surgical procedure aimed at increasing bladder capacity and improving its storage function. This operation is primarily indicated for patients with insufficient bladder capacity due to nerve damage or congenital abnormalities, such as spinal cord injury or spinal muscular atrophy. The surgery involves implanting intestinal tissue or synthetic materials into the bladder wall to enable the bladder to store more urine, thereby reducing incontinence and lowering the risk of upper urinary tract damage.
The core goal of this treatment is to restore normal bladder physiology and prevent permanent kidney damage caused by urine reflux. Postoperative long-term follow-up includes residual urine measurement and renal function tests to ensure the effectiveness of the treatment.
Based on the source of tissue used, bladder augmentation can be classified into "Intestinal Cystoplasty" and "Artificial Material Implantation." Intestinal procedures often use ileum or sigmoid colon due to their flexibility and regenerative capacity; artificial materials typically involve special biocompatible substances directly affixed to the bladder surface. During surgery, tissue or materials are sutured to the bladder wall to enlarge the bladder cavity, extending urine storage capacity.
The mechanism involves increasing bladder capacity to over 300-500cc and reducing intravesical pressure. Some patients may also require sphincterotomy to further improve urination obstruction. Bladder function recovery after surgery takes 3-6 months, during which regular urodynamic studies are necessary.
The primary candidates include:
This surgery is also suitable for congenital bladder hypoplasia or bladder scarring and contraction caused by trauma. However, patient overall health status, including cardiopulmonary function and metabolic control, should be evaluated to reduce surgical risks.
The procedure is usually performed under general anesthesia, requiring hospitalization for 5-7 days. Intestinal segment transplantation involves harvesting about 10-15 cm of intestine, which is then anastomosed to the bladder; artificial materials are directly inserted into the bladder cavity. The operation lasts approximately 3-5 hours, depending on tissue source and complexity of complications management.
Postoperative care includes urethral catheterization for 2-4 weeks until healing, followed by training in intermittent catheterization. Patients need to learn self-catheterization techniques and keep a urination diary. Follow-up occurs every 3 months in the first year, then every six months thereafter.
The main advantages include:
Compared to traditional long-term catheterization, this surgery can reduce urinary tract infections and improve psychological well-being. Long-term follow-up shows that 70-80% of patients maintain good bladder function five years post-operation.
Main risks include:
Long-term complications may include bladder stone formation, abnormal urine pH, or electrolyte disturbances due to intestinal absorption. About 5-10% of patients may require secondary surgery for correction.
Contraindications include:
Preoperative evaluation should include urethroscopy and urodynamic studies. Diabetic patients should have blood glucose controlled below HbA1c 8%, otherwise surgery may be delayed.
Patients should avoid anticoagulants (e.g., warfarin) for at least 2 weeks post-surgery. Those undergoing radiotherapy or chemotherapy should coordinate treatment schedules with oncologists. Patients on alpha-blockers or bladder smooth muscle relaxants should discontinue these medications two weeks before surgery.
Other urinary surgeries (e.g., urethroplasty) should be scheduled after bladder augmentation to avoid interfering with healing. Pelvic floor muscle training with a physiotherapist is recommended postoperatively.
Randomized controlled trials show that intestinal cystoplasty has a 75% success rate at 5 years, while artificial material implantation is 65%. In patients with neurogenic bladder, postoperative daytime incontinence reduces by an average of 60-80%.
Long-term studies indicate that patients undergoing this surgery have a 40% lower rate of renal function deterioration compared to untreated groups. However, intestinal segments may alter urine pH, requiring regular urine testing.
Alternatives include:
Non-surgical options are less invasive but have poorer long-term control. Choice depends on patient age, neurological injury severity, and lifestyle needs.
Preoperative assessment should include detailed urological examinations, including urodynamics and imaging, to evaluate bladder function. Patients should discuss current medications with their doctor and adjust drugs that may affect surgery (e.g., anticoagulants). Starting bowel preparation three days before surgery and following medical instructions can reduce infection risk during the operation.
How is postoperative urinary incontinence managed?Some patients may experience temporary incontinence initially after surgery. Pelvic floor muscle training is recommended, practicing muscle contractions 30 times daily in three sets. If persistent, electrical stimulation or protective pads may be used. Regular follow-up should include honest reporting of urination patterns, and doctors will adjust treatment accordingly.
What dietary and daily activity precautions are needed after surgery?During the first week, avoid heavy lifting and vigorous exercise to reduce tension on sutures. Diet should include high-fiber foods (whole grains, vegetables) and 1.5-2 liters of water daily, avoiding excessive caffeine or spicy foods to prevent bladder irritation. For constipation, physicians may prescribe laxatives to prevent straining during bowel movements.
What is the recommended frequency and main focus of follow-up examinations?In the first year, bladder ultrasound or uroflowmetry should be performed every 3-6 months to assess capacity and voiding function. Follow-up intervals are adjusted based on recovery, typically extending to once a year after 2-3 years. Long-term monitoring includes regular serum potassium measurements, as intestinal segments may affect electrolyte balance.
Can long-term quality of life return to normal after surgery?Approximately 80-90% of patients can resume daily activities after adapting to the new urination pattern. Some may need intermittent catheterization or dietary adjustments, but most maintain a stable quality of life. Adherence to medical instructions and regular monitoring of bladder function are key to preventing complications and ensuring long-term success.
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