Enlargement of the bladder using a segment of bowel

What is this?

This involves enlargement of the bladder through a lower abdominal incision by taking an isolated segment of bowel, and forming this into a patch that is sewn into an opening made in the bladder

What alternatives are there?

Observation, bladder training, pelvic floor exercises, drugs, injections into the bladder, urinary diversion, neuromodulation (elctro-stimulation of the nerves to the bladder).

What to expect before procedure

A pre-clerking appointment will also be sent to you to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. You will come into hospital on the day before surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer, your named nurse and possibly a Urology Nurse Specialist. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You will given fluids only by mouth before your day of surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. Through an incision in your lower abdomen, the bladder will be opened and spilt almost in two. The two halves will then be joined together using a patch fashioned from an isolated segment of bowel and the ends of the bowel from where the segment has been taken will be re-joined.

After the procedure

The average stay in hospital will last approximately 10-14 days Two catheters will be placed in the bladder for about two to three weeks, one via the urethra and one (suprapubic catheter) via a small incision in the skin over the bladder. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach. After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm and you may have a further drip into a vein in your neck. You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation. It will, however, take at least 6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.

Potential side effects