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Thread: Surgically expanding size of bladder

  1. #1
    Senior Member
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    Surgically expanding size of bladder

    Hi there,
    I have a friend who's not able to retain more than 200 ml. in his bladder. As a result, he's constantly leaking because it doesn't take much for his bladder to fill up.

    His urologist has told him it's either foley or a surgery to expand the size of his bladder. Has anyone done the bladder surgery and if so, what were the results, side effects and post-op challenges/problems? What should he be concerned with?

  2. #2
    Bladder capacity can be limited either because the bladder is contracted and shrunken, or because bladder spasms occur (instability) at a low capacity. With the latter, bladder injections with Botox would be the next step if oral medications cannot control the high pressures and spasms. If the bladder is actually contracted (more common if the person has used an indwelling catheter or other continuous drainage of the bladder for some time), then a major surgical procedure called a bladder augmentation (also called a clam-shell cystoplasty) may be recommended.

    This is a major surgery...I tell my patients it will feel like they were hit by a truck for about 7-10 days. A segment of large bowel (occasionally stomach is used instead) is separated from the colon (with the blood vessels intact) and fashioned into a sheet of tissue. The bladder is split lengthwise and the bowel segment is sewn in place like a patch. This makes the bladder larger, with lower pressures. When you come out of surgery, you have an NG tube down your nose (no eating for up to 7 days) and multiple catheters in the bladder and often in the ureters as well. There is a good sized abdominal incision to heal in addition to the augmented bladder sutures.

    Once it is healed, intermittent catheterization must be done (reflex voiding is not an option). Multiple catheters are in place while the healing occurs and are removed at about 2-3 weeks. At first intermittent cath may need to be done as often as every 2 hours to avoid stressing the suture lines, but generally good results would be to be able to cath every 4-5 hours with a capacity of 450-500 cc.

    Do a search on our forums using the word "augmentation" and you will find many previous discussions about this.

    Your friend needs to find out why his capacity is low, as if it is primarily the spasm and not the contracture of the bladder, Botox should be considered prior to this major surgery.


    (KLD)

  3. #3
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    Wow, what an ordeal. But thanks so much for the info.

    I don't have all the details on his conversation with the urologist but when he told me on the phone about the surgery, I automatically thought this can't possibly be good. I'll be seeing him this weekend and find out more.

  4. #4
    Senior Member jessie.gray's Avatar
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    Quote Originally Posted by SCI-Nurse View Post
    Bladder capacity can be limited either because the bladder is contracted and shrunken, or because bladder spasms occur (instability) at a low capacity. With the latter, bladder injections with Botox would be the next step if oral medications cannot control the high pressures and spasms. If the bladder is actually contracted (more common if the person has used an indwelling catheter or other continuous drainage of the bladder for some time), then a major surgical procedure called a bladder augmentation (also called a clam-shell cystoplasty) may be recommended.

    This is a major surgery...I tell my patients it will feel like they were hit by a truck for about 7-10 days. A segment of large bowel (occasionally stomach is used instead) is separated from the colon (with the blood vessels intact) and fashioned into a sheet of tissue. The bladder is split lengthwise and the bowel segment is sewn in place like a patch. This makes the bladder larger, with lower pressures. When you come out of surgery, you have an NG tube down your nose (no eating for up to 7 days) and multiple catheters in the bladder and often in the ureters as well. There is a good sized abdominal incision to heal in addition to the augmented bladder sutures.

    Once it is healed, intermittent catheterization must be done (reflex voiding is not an option). Multiple catheters are in place while the healing occurs and are removed at about 2-3 weeks. At first intermittent cath may need to be done as often as every 2 hours to avoid stressing the suture lines, but generally good results would be to be able to cath every 4-5 hours with a capacity of 450-500 cc.

    Do a search on our forums using the word "augmentation" and you will find many previous discussions about this.

    Your friend needs to find out why his capacity is low, as if it is primarily the spasm and not the contracture of the bladder, Botox should be considered prior to this major surgery.


    (KLD)
    I am still debating on wheather to have an augmentation done or just get a urostomy done to stop my bladder accidents becuase Botox shots didn't work.
    I was wondering if using part of your stomach for the augmentation would screw up a feeding tube. I got a GJ feeding tube implanted in late January/early Feburary because of gastroparesis, and I don't want anything to get screwed up.
    Also, if all your medicines and stuff go through the jejunal part of that tube, do you still need an NG tube during the augmentation procedure? I absolutely can't stand getting NG tubes placed!

    Jessie

  5. #5

    Unhappy

    Quote Originally Posted by SCI-Nurse View Post
    Bladder capacity can be limited either because the bladder is contracted and shrunken, or because bladder spasms occur (instability) at a low capacity. With the latter, bladder injections with Botox would be the next step if oral medications cannot control the high pressures and spasms. If the bladder is actually contracted (more common if the person has used an indwelling catheter or other continuous drainage of the bladder for some time), then a major surgical procedure called a bladder augmentation (also called a clam-shell cystoplasty) may be recommended.

    This is a major surgery...I tell my patients it will feel like they were hit by a truck for about 7-10 days. A segment of large bowel (occasionally stomach is used instead) is separated from the colon (with the blood vessels intact) and fashioned into a sheet of tissue. The bladder is split lengthwise and the bowel segment is sewn in place like a patch. This makes the bladder larger, with lower pressures. When you come out of surgery, you have an NG tube down your nose (no eating for up to 7 days) and multiple catheters in the bladder and often in the ureters as well. There is a good sized abdominal incision to heal in addition to the augmented bladder sutures.

    Once it is healed, intermittent catheterization must be done (reflex voiding is not an option). Multiple catheters are in place while the healing occurs and are removed at about 2-3 weeks. At first intermittent cath may need to be done as often as every 2 hours to avoid stressing the suture lines, but generally good results would be to be able to cath every 4-5 hours with a capacity of 450-500 cc.

    Do a search on our forums using the word "augmentation" and you will find many previous discussions about this.

    Your friend needs to find out why his capacity is low, as if it is primarily the spasm and not the contracture of the bladder, Botox should be considered prior to this major surgery.


    (KLD)
    Hi Wise/KLD. Hope all is going well with you both and that the rats don't bite Wise too often. ;-)

    Now, I've gone straight past botox, didn't pass go, didn't collect $200, and have ended up
    on Bladder Augmentation Avenue. I am trying to understand what are the typical outcomes of this type of surgery through Pub Med and other journals but I am not finding enough info to my liking. I am concerned about early and late complication rates as I have read them to be as high as 44% (Glenn's urologic surgery By Sam D. Graham, James Francis Glenn, Thomas E. Keane; http://books.google.ca/books?id=AeZJ...ation+outcomes).

    For the community's use, is it even possible to fill in the following table? I know that every study is different, but can anyone draw any general conclusions about the outcomes of Bladder Augmentation?

    For example, early (x), late (y) and total (z) complications of Bladder Augmentation:

    - X%/Y%/z% stone formation
    - X%/Y%/z% bowel obstruction
    - X%/Y%/z% metabolic malabsorption
    - X%/Y%/z% cancer
    - X%/Y%/z% other (rupture, reservoir too small, etc).
    - X%/Y%/z% Worsening of bowel dysfunction (frequency, looser consistency, etc)
    - X%/Y%/z% other complications I don't know about to be added to the list


    Any info is much appreciated or even links will do!

    -K

  6. #6
    Senior Member
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    I had this done and more

    THIS IS A HUGE, painful, dangerous and really scary surgery for SCI patents It is a huge operation for normal persons... but with a SCI it is really as tough as you can get. I recently had this procedure and it nearly killed me. I seriously would never ever suggest it... only as a last resort to save life. It is nearly impossible to heal, because we cant move and when we do, we tear things up that we not intended to be stressed. It is so hard to heal and take of yourself. The patient need 100% constant care, absolutely cannot hold your head up by yourself, because of the huge incision and surgery! You cant even read a newspaper. It took 8 weeks of terrible terrible Neuro pain... caused my the surgery. The severity of the surgery made my normal level of Neuro pain absolutely go through the roof. I wanted to end it all many times during the ordeal. Just say no to this type of surgery.. it is HELL!
    Mike (Florida)

    Cant we get 1 do over?

  7. #7
    Quote Originally Posted by SCI-Nurse View Post
    Bladder capacity can be limited either because the bladder is contracted and shrunken, or because bladder spasms occur (instability) at a low capacity. With the latter, bladder injections with Botox would be the next step if oral medications cannot control the high pressures and spasms. If the bladder is actually contracted (more common if the person has used an indwelling catheter or other continuous drainage of the bladder for some time), then a major surgical procedure called a bladder augmentation (also called a clam-shell cystoplasty) may be recommended.

    This is a major surgery...I tell my patients it will feel like they were hit by a truck for about 7-10 days. A segment of large bowel (occasionally stomach is used instead) is separated from the colon (with the blood vessels intact) and fashioned into a sheet of tissue. The bladder is split lengthwise and the bowel segment is sewn in place like a patch. This makes the bladder larger, with lower pressures. When you come out of surgery, you have an NG tube down your nose (no eating for up to 7 days) and multiple catheters in the bladder and often in the ureters as well. There is a good sized abdominal incision to heal in addition to the augmented bladder sutures.

    Once it is healed, intermittent catheterization must be done (reflex voiding is not an option). Multiple catheters are in place while the healing occurs and are removed at about 2-3 weeks. At first intermittent cath may need to be done as often as every 2 hours to avoid stressing the suture lines, but generally good results would be to be able to cath every 4-5 hours with a capacity of 450-500 cc.

    Do a search on our forums using the word "augmentation" and you will find many previous discussions about this.

    (KLD)
    KLD, I have not heard of this surgery before, but I wonder why an illeal conduit, which I have, would not be preferable if you are going to do that kind of massive surgery. Changing a urostomy pouch every 4 days is very easy to deal with, and I have been infection free since 1970. Conduits seem less complicated.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  8. #8
    Quote Originally Posted by mike bauer View Post
    THIS IS A HUGE, painful, dangerous and really scary surgery for SCI patents It is a huge operation for normal persons... but with a SCI it is really as tough as you can get. I recently had this procedure and it nearly killed me. I seriously would never ever suggest it... only as a last resort to save life. It is nearly impossible to heal, because we cant move and when we do, we tear things up that we not intended to be stressed. It is so hard to heal and take of yourself. The patient need 100% constant care, absolutely cannot hold your head up by yourself, because of the huge incision and surgery! You cant even read a newspaper. It took 8 weeks of terrible terrible Neuro pain... caused my the surgery. The severity of the surgery made my normal level of Neuro pain absolutely go through the roof. I wanted to end it all many times during the ordeal. Just say no to this type of surgery.. it is HELL!

    Oh dear. This is not what i needed to hear!

    I just chickened out of this surgery 2 months ago, but I know even though I hold 500mls easily that I have a high pressure bladder and will have to get something done within a year or so.

    I've been told I could have renal damage if I don't do something about it, but it's my call.

    The other option is a sphinctorotomy and that sounds awfull too!
    My last scans showed my kidneys were ok so I asked to postpone the op and have another urodynamics pressure test (next month), my last pressures were 100+
    I guess I'll have to bite the bullet, better make a will too!

  9. #9
    Before you make any decisions, see what is going on with your urodynamics. Then I would encourage you to make sure that you think through all of your options, get your questons answered and speak to as many people who have had it as you can.

    Then weigh your options before making any decisions.

    CKF

  10. #10
    Quote Originally Posted by SCIfor55yrs. View Post
    KLD, I have not heard of this surgery before, but I wonder why an illeal conduit, which I have, would not be preferable if you are going to do that kind of massive surgery. Changing a urostomy pouch every 4 days is very easy to deal with, and I have been infection free since 1970. Conduits seem less complicated.
    SCI Nurse, what about SCIfor55yrs's question as an alternative?

    In this great medical age why not use donor tissue of some kind instead of such butchery?

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