Kids Health Info

Bladder augmentation

  • How you say it: Augmentation - org-men-tay-shon

    The bladder is the part of the body where urine (wee) is stored.  Children who have a small bladder may need bladder augmentation, which is an operation to make the bladder larger. Most children who need this operation have a medical condition which causes them to have a small bladder (e.g. spina bifida, posterior urethral valves, sacral agenesis, bladder exstrophy). The operation prevents further damage to the kidneys and can help fix problems such as urine leakage. 

    Why is the operation done?

    Children who have this operation have small bladders, usually with thick walls. The job of the bladder is to hold urine (wee) until we go to the toilet. If the bladder is small, it can not hold much urine. If there is a lot of urine, the bladder is put under a lot of pressure. This causes the urine to either leak out of the bladder or flow back up to the kidneys. The kidneys can then become swollen and damaged by this back pressure. If the bladder is made bigger, it can hold more urine at a lower pressure. 

    How is the bladder enlarged?

    This is different for each child.  Part of the ureters (tubes from the kidneys to the bladder), the stomach or the small or large intestine can all be used to enlarge the bladder. Sometimes, because of the back flow of urine, the ureters become big and floppy. This means they can be cut and used to make the bladder larger.  If this is not possible, a piece of intestine (bowel or gut) may be used. Intestine tissue is good tissue to use because the body can cope when some of it is removed.

    Risks of this surgery

    All operations have risks. There are several short and long term risks that are associated with bladder augmentations. The risks can be a bit different depending on the type of tissue (ureter or bowel/intestine) that is used. The urologist (medical specialist) will talk about this with you and your child in the clinic.  

    The first (and short term) risk is the anaesthetic, and the anaesthetist will discuss this in more detail on the day of the operation.

    Other risks include:

    Bladder rupture (the bladder can tear or rip)

    There is a risk of rupture if too much pressure is put on the bladder. Emptying the urine from the bladder often lowers the pressure. This reduces the risk of rupture.

    Urinary tract infection (UTI)

    If a part of the intestine is used, bacteria and bugs that normally grow happily in the intestine may start to grow in the bladder.  This can cause a UTI. If your child gets symptoms of a UTI such as pain or stinging when weeing, a fever, bladder pain or blood in the urine, they will need antibiotics.

    Higher salt levels in the blood

    If bowel tissue is used for an augmentation, the way the body absorbs food changes. This means that the salts in the blood can be higher. A blood test each year to check how the kidneys are working is a good way to see how the body is dealing with the extra salt in the blood.

    Vitamin B12 in the blood

    If the tissue from the small bowel is used, the way vitamin B12 is absorbed changes. A blood test each year checks the levels of vitamin B12 in the blood.

    Gallstones

    If small intestine tissue is used, there is a risk of developing stones in the gallbladder, called gallstones. An ultrasound of the bladder is the best way to check if there are any gallstones in your child's bladder.

    Mucus in the bladder

    If intestine tissue has been used in the augmentation, it will keep making mucus. Passing a catheter into the bladder to wash out the mucus is sometimes needed.

    Bladder stones

    One of the reasons why bladder stones can develop is because the mucus in the bladder acts as a carrier for some of the chemicals in urine. These chemicals attach themselves to the mucus and they can harden and become too large to pass through the catheter. An annual ultrasound of the bladder will look for any bladder stones.

    Bladder cancer

    If intestine tissue is used, there is about a 1% risk (one person in every 100 who has the procedure) that bladder cancer can develop. At the moment, bladder cancers have only been seen 10 years or more after the operation. It is thought the intestine tissue can react with the urine, causing the bowel cells to change and become cancerous. Your child will need life-long follow up with an annual cystoscopy (looking at the bladder with a small camera) and biopsy (taking some cells and testing) to check for cancer cells. Keeping the bladder healthy is important - don't smoke, empty the bladder often and treat UTIs quickly.  These are all very effective ways of keeping the bladder healthy.

    Despite these risks, many children have gone ahead and had their bladders augmented. Surgeons around the world have been doing this operation since the early 1980s. If affected children did not have this operation, some would develop severe kidney damage, perhaps even needing a kidney transplant, or have ongoing urinary incontinence.

    At home care

    Care at home after a bladder augmentation involves:

    • Regular catheterisation of the bladder to stop it getting too full.
    • Watching  your child for any signs of a urinary tract infection and making sure they are treated with antibiotics as soon as any symptoms appear.

    Follow-up

    All children who have had a bladder augmentation must have life-long follow up with a urology doctor. Everyone who has had a bladder augmentation must see the urologist at least once every year. Some children may have ongoing problems with incontinence and may need to see the specialist more often. 

    It is recommended that after a bladder augmentation, all children have the following at least once every year for the rest of their life:

    • A cystoscopy (a look inside the bladder with a special camera) and biopsy (a small piece of tissue is taken and checked under the microscope).
    • An ultrasound of their kidneys and bladder.
    • A routine blood test.
    • A urine test to look for bacteria in the urine.

    Key points to remember

    • Bladder augmentation is an operation to make the bladder larger if it is too small.
    • Bladder augmentation can stop the kidneys from becoming damaged and can help improve urine continence for children with a small bladder.
    • Ureter, stomach, small and large intestine tissue can all be used to enlarge the bladder.
    • There are several risks linked to the operation, so life-long follow up is necessary to monitor kidney and bladder health and check for signs of bladder cancer.

    For more information

    • Talk to your family doctor (GP), paediatrician or urologist.
    • See: Spina Bifida Foundation in Victoria www.sbfv.org.au

     

    Developed by the RCH Dept of Urology. First published: January 2008. Updated september 2012.


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