The bladder is the part of the body where urine (wee) is stored. A child with a small bladder may need a bladder augmentation, which is an operation to make the bladder larger.
Most children who need this operation have a medical condition that causes them to have a small bladder (e.g. spina bifida, posterior urethral valves, sacral agenesis, bladder exstrophy). The operation prevents serious damage to the kidneys and can help fix problems such
as urinary incontinence (leakage).
Why does my child need a bladder augmentation?
The job of the bladder is to hold urine until the person can go to the toilet. If the bladder is small, it cannot hold much urine. If there is a lot of urine, a small 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. A bladder augmentation will make the bladder bigger, so it can hold more urine at a lower pressure.
A bladder augmentation can help prevent severe kidney damage, which can lead to the need for a kidney transplant.
What to expect with a bladder augmentation
Before surgery
You will be given instructions from your doctor or nurse on fasting before the surgery. It’s important to follow these directions.
Your child will have a general anaesthetic, which will put them to sleep before the surgery. The surgeon, anaesthetist (doctor who puts your child to sleep during the operation) and nurses will explain all the procedures to you before the operation begins. If you have any questions or
anything is unclear, ask staff to explain as many times as needed.
During surgery
There are many different ways a bladder augmentation can be carried out, and it will depend on your child's condition.
In most cases, part of the small intestine (bowel) is used to enlarge the bladder. Part of the ureters (tubes from the kidneys to the bladder), the stomach or the large intestine can also be used. Intestine tissue is good tissue to use because the body can comfortably cope
when some of it is removed.
After surgery
When the surgery is over, you will be called to your child’s bedside to be there when they wake up. Some children take longer than others to wake up, and they may be confused, feel sick or vomit.
Your child will be able to go home when they're eating and drinking and the doctor is happy that they are recovering adequately.
Care at home
You will be given discharge care instructions when you leave the hospital. Follow these instructions carefully. They will cover information including:
- what your child can eat and drink
- managing your child's nausea and vomiting
- pain management
- looking after your child's catheter (see our fact sheet
Urinary catheters)
- symptoms to look out for that require medical advice
- any follow-up appointments your child will need to have.
You will need to watch your child for any signs of a urinary tract infection (UTI), such as:
- pain or burning when passing urine (doing a wee)
- pain in the lower part of the abdomen (under the belly button)
- needing to go to the toilet frequently to urinate
- passing some urine before getting to the toilet (wetting or incontinence)
- smelly or discoloured urine
- a fever or vomiting.
If your child shows symptoms of a UTI, take them to the GP and contact your child's surgeon. Your child will need to be treated with antibiotics as soon as possible.
After bladder augmentation, keeping the bladder healthy is very important. To decrease the risk of UTI, ensure that your child drinks plenty of fluids and regularly empties their bladder completely (you will be given instructions about this). Good management of constipation is also
important. When they are older, strongly discourage your child from smoking as it increases the risk of complications (see below).
What are the risks?
Talk to your child's doctor to weigh up whether bladder augmentation is the right course of treatment for your child. All operations have risks. There are several short- and long-term risks that are associated with bladder augmentations.
The risks depend on the type of tissue (intestine or ureter) that is used. The urologist (medical specialist) will talk about this with you and your child.
There is a short-term risk associated with the general anaesthetic, and the anaesthetist will discuss this with you on the day of the operation.
Children who have had a bladder augmentation are also at risk of the following complications:
- Bladder rupture: This means that the bladder can tear or rip if too much pressure is put on the bladder. However, emptying the urine from the bladder often (either on the toilet or via a catheter) lowers the pressure and reduces the risk of rupture.
- 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.
- Vitamin B12 in the blood: If the tissue from the small bowel is used, the way vitamin B12 is absorbed changes. Low vitamin B12 can lead to anaemia.
- Mucus in the bladder: It is normal for intestine tissue to make mucus. When it has been used in an augmentation, it will keep making mucus, which can cause problems. Passing a catheter into the bladder to wash out the mucus is sometimes needed.
- Bladder stones: If small intestine tissue is used, there is a risk of developing stones (hardened lumps of chemicals) in the bladder.
- Bladder cancer: If intestine tissue is used, there is about a one per cent risk that bladder cancer can develop. To date, 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.
Regular follow-up appointments (see below) will monitor your child for signs of these complications so they can be addressed quickly.
Follow-up
All children who have had a bladder augmentation must have life-long follow-up and see a urologist (doctor specialising in the urinary tract) 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 your child has a blood test and ultrasound of their kidneys and bladder at least once every year for the rest of their life.
Key points to remember
- Bladder augmentation is an operation to make the bladder larger if it is too small.
- Bladder augmentation can prevent severe kidney damage and urinary incontinence for children with a small bladder.
- Intestine, ureter and stomach 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.
For more information
Common questions our doctors are asked
I am worried about the risks associated with bladder augmentation.
Are there any alternatives to this surgery?
The need for surgery will depend on your child's condition.
When non-surgical options are available, these will be explored before deciding
on bladder augmentation surgery. Sometimes, the risks of surgery do not
outweigh the benefits following bladder augmentation surgery.
How long will it take my child to recover from the surgery?
Most children recover quickly from bladder
augmentation surgery and usually only spend a few days in hospital. Once your
child is eating and drinking, with minimal pain and good bladder function, they
are able to return home.
Developed by The Royal Children's Hospital Urology department. We acknowledge the input of RCH consumers and carers.
Reviewed August 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.