What is cystoplasty?
Cystoplasty, also called bladder augmentation or augmentation cystoplasty, is a type of surgery that improves your bladder’s ability to hold urine. Your bladder may not be large enough to hold urine or be stiff or stretchy enough. As a result, you can develop frequent urination, urinary incontinence or urine can back up into the ureters (tubes that carry urine from your kidneys to your bladder), leading to recurrent urinary tract infections (UTIs) or kidney damage.
Why might I need a cystoplasty?
Rarely performed on adults, cystoplasty is usually done in children with spina bifida or other congenital bladder issues. Your provider may recommend a cystoplasty if conservative treatments or medications have not helped your urinary incontinence and you continue to experience leaks or urinary urgency (overactive bladder).
Cystoplasty is used to treat various bladder conditions
- Bladder capacity: When the bladder is too small to hold normal amounts of urine.
- Bladder pressure: When high pressure in the bladder risks damaging the kidneys.
- Bladder muscle function: When bladder muscles don’t function properly, such as not stretching enough.
- Bladder dysfunction: When the bladder is impacted by neurogenic or non-neuropathic causes, like spinal cord injury, multiple sclerosis or myelodysplasia.
- Bladder disorders: When the bladder is affected by inflammatory or infectious conditions.
How to prepare for cystoplasty
Before you have a cystoplasty, your provider will perform tests to ensure it is the right procedure for you and to determine the best way to perform one. The tests may include:
- Physical exam
- Blood tests
- Cystoscopy
- Imaging tests to view your upper urinary tract
- Tests to measure pressure in your bladder (urodynamic testing)
- Urodynamic testing to check for infections or other problems
Your surgical team will give you detailed instructions about what to do on the day of your procedure and when to arrive. Follow these closely to ensure you’re fully prepared for your cystoplasty. Tell them about your medications, including over-the-counter drugs, prescriptions, herbs, vitamins and supplements. Before the procedure, you may need to stop some medications, like blood thinners.
The cystoplasty procedure
A cystoplasty can take a few hours, and you will likely need to stay in the hospital for a few days.
Before the procedure
You may need to empty your bowels the day and night before your procedure. Your care team will give you instructions on how to do this.
Your surgeon will meet with you to provide detailed information about the operation and address any concerns you may have. An anesthetist will also talk with you about anesthesia and how your pain will be managed after surgery. Be sure to inform your providers about any medical issues, such as allergies.
During the procedure
Your surgeon will begin by cutting into your abdomen to access your bladder. Next, the surgeon:
- Makes a cut in the top of your bladder
- Removes tissue from another area of your body, such as your stomach or intestines
- Secures the tissue to the bladder opening, like a patch, with sutures that your body will eventually absorb
You may also have a catheter placed during the procedure, which will either be inserted into the urethra or out through the abdomen.
After the procedure
You will stay in the hospital for a few days until you can eat or drink on your own. At first, you will receive food and fluids through an intravenous (IV) tube. After a few days, you can switch to clear liquids and eventually start eating solid foods.
Cystoplasty can prevent your bowels from working, so you may also have a temporary tube inserted that empties the contents of your stomach and bowels for you as your bowels recover.
Your care team will also teach you how to use a catheter to drain urine. The catheters also help clear your bladder of mucus. The tissues used during your procedure may create mucus, which can enter your bladder and keep urine from emptying. You will need to clear this mucus for the rest of your life to prevent kidney or bladder stones and UTIs.
Understanding the outcomes
In the weeks after your surgical procedure, your provider will see you regularly to ensure your bladder capacity has improved and you are healing properly. You may also need more imaging and urodynamic tests. Your provider will make sure you feel comfortable clearing mucus and teach you how to self-catheterize.
Most people can return to work in about six weeks, but full recovery may take up to three months. During this time, you will need to avoid intense activities, such as heavy lifting, sex and exercise.
The majority of people having bladder augmentation have good outcomes and experience a better quality of life after the surgery.
Attend all follow-up appointments to catch and address any complications early. Complications of bladder augmentation include:
- Diarrhea
- Hernias
- Incontinence, which can be related to mucus or problems with your catheter
- Kidney and bladder stones
- Nutrient deficiencies or an inability to absorb certain nutrients
Bladder cancer is a possible long-term complication of cystoplasty, developing between four years and 20 years after surgery. Your provider may recommend screening tests to detect and treat it early.