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Thread: Bladder augmentation on Fri.!

  1. #1
    Senior Member SurfCat's Avatar
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    Bladder augmentation on Fri.!

    I AM scheduled to have my bladder augmented in 4 days and still have some questions (my dr. is an amazing surgeon but no communicator):

    What is your new bladder capacity? catheterize how often? do you have to watch your intake of fluids?

    How difficult is day-to-day management? Is there much mucous?

    Would you recommend it and why?


    Thanks for everyone's help--big-time...I'm just not sure what to do.

    PS -- does anyone have the drainage bag option...how does this work for you?

  2. #2
    Just a few comments:

    You will probably need to cath every 2-3 hours initially once they remove the foley. This is to prevent any disruption of the surgical incisions in the bladder which could result in leakage of urine into your abdomen. Most people go on to cath every 4-6 hours depending on their fluid intake.

    You will still need to watch your fluids and adjust your caths. It is still recommended that you have a maximum of about 500 cc. in your bladder at any one time.

    Mucous is usually an issue. We recommend flushing with normal saline through the catheter at the end of a cath 1-2X daily. Over time (like 6-12 months) the need to do this may reduce, but that is an individual thing.

    You also need to discuss with your physician management of metabolic acidosis, which is common because your intestinal part of the augment will absorb H+ ions from the urine. This can result in a metabolic acidosis (more acid blood than normal). Usually this is managed by taking sodium bicarbonate tablets on a regular basis. Like the mucous, this result of the surgery may get better over time. Many of our patients have been able to stop the tablets at about 9-12 months after surgery.

    Not sure what you mean by the "drainage bag option". We do not recommend putting a catheter in overnight as this will increase your risks of UTI, stones, and bladder shrinkage once again.

    (KLD)

  3. #3
    What is your new bladder capacity?
    low end-400, high end-650

    catheterize how often?
    4-4.5 hrs max, more often if i happen to drink more volume

    do you have to watch your intake of fluids?
    yes, esp to get through the night dry

    How difficult is day-to-day management?
    cath in the shower am, lunch time, early eve, before bed, once during night

    Is there much mucous?
    no, but i still irrigate 2x/day

    Would you recommend it and why?
    everything has pluses/minuses, this included. ever since getting it a yr ago, i've been infection free (was avging about 5/yr before), good to get rid of the bag, not penis skin breakdown, wear shorts

    con-fluid restriction, having to conform to cath schedule, whenever and wherever

    my advice, cath first for at least a month to see if you can and want to do it. if you're a quad and will be doing it, practice to see if you can handle cath, bags, lube etc, if it frustrates you before, though it is easier through the stoma, you may just not want to do it

    find out how he handles reflux up the chimney, there are several surgical options avail, each with ramifications

    once the decision is made, relax and think positive

  4. #4
    When you're talking about the "drainage bag option" are you talking about where they take a piece of intestine and make a tube from your bladder to an external bag, so its kinda like an SP in that it drains constantly but theres not a tube inside your bladder. If so I would try and see if you could do just an enlargement or with the mitranoff instead so you can just cath into it and not have all the bags and tubes, you could probably do it even with limited hand use. If they do what I think you're talking about its more like a colostomy for urine, and they might not even make your bladder bigger since its gonna drain constantly anyway. Also you'll have some of the same infection problems because its always open and attached to a bag. I replied with similar comments in another one of your posts but I didn't know if you read it or not.

  5. #5
    Senior Member SurfCat's Avatar
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    Thanks for the replies.

    Crags - do you think it will work to try intermittent cathing by just taking out my sp tube, even though my bladder is tiny with high pressures? Why do you still irrigate if there's not much mucous?

    The Dude - do you have the augmentation? What is mitranoff referring to?

  6. #6
    For instance, you can try cathing through the penis with assistance, with you doing the insertion. You don't practice through a SP stoma. It's the insertion technique you want to try out. Has the uro stoma nurse eval'ed you for being an approp candidate? What level are you? IMO, C6 will prob be able to do it w/o min diff, C7 more so, C5 will prob not be able to. Try handling a cath, lubing it up, moving clothes out of way, etc. I was cathing with assistance for about 2 months prior; I knew I could handle the supplies. The belly button stoma just made it easier; though at times it can a pain. I'm healthier since having it done.

    Good luck.

  7. #7
    Yes I have had a bladder augmentation, all I had done though was have my bladder enlarged because it had shrunk from having a SP for so long. I didn't have a mitranoff, which is when the hole you cath into is made in or around your belly button using intestine and is able to close. What they wanted me to do at first which was what I thought you might have been talking about is an augmentation where they take a piece of intestine make a tube and attach it to a bag so it drains constantly, you don't wanna get that if theres anyway you would be able to self cath. You really should know exactly what they are going to do, if they havent talked to you about being able to self cath or a mitranoff it sounds like they may be doing the bag attachment type. Its just what I got from your post you may know and just didnt say and I don't wanna make you nervous

  8. #8
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    Ask about bowel control ASAP! By removing part of the intestine to create the stoma, you will lose part of the intestine. I had this operation in April 2002 and still have bouts of diarhea. They forget to to tell you about this aspect of the surgery. The surgery is worth it for the simple convience aspect of not having to remove clothes, although the uncontroled diarhea may leave you homebound until/if you can get it under control. Their may be some health benefits, such as a reduction in UTI's, Do not take their advice and reuse catherters....most insurance will more than pay for supplies.

  9. #9
    Disruption of your bowel routine does often occur, but rarely does this last more than 4-6 weeks unless you have a supra-infection with c.diff. or other problems related to the surgery.

    The surgery where your urine is diverted to an ostomy on the abdomen where you wear an appliance all the time and drain into a bag is a completely different surgery from an augmentation. This is called a urinary diversion, and there are several types. The most common is a Bricker or ileal conduit. The ureters are removed from the bladder (which can be removed completely or left in the pelvis and unused) and attached to a segment of small bowel. Unlike with a Mitrofanoff, this diversion drains constantly. This is rarely used anymore due to better bladder management procedures. It is often associated with problems with stones and UTIs, and of course you do have to manage the bag and changing the appliance (glued to your abdomen) every 3-4 days.

    (KLD)

  10. #10
    Senior Member SurfCat's Avatar
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    Dude -- Do you still have your SP tube in your augmented bladder? Does that work?

    KLD -- My doc is giving me the option of having an augmentation w/ cathing or bag drain. He basically invented the surgery (dr. raz at ucla) so I think he's good. I'm C5-6 so having aw hard time deciding which 1.

    I'm nervous about all the changes but am going to go for it, through God's grace all will go well.

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