Neobladder formation

Bladder augmentation, also called augmentation cystoplasty, is a surgical procedure used in adults who lack adequate bladder capacity or detrusor compliance. For many patients, augmentation cystoplasty can provide a safe functional reservoir that allows for urinary continence and prevention of upper tract deterioration. The procedure allows for enlargement of the bladder using a segment of the bowel.

During surgery, the top dome of the bladder is opened and a segment of the bowel is inserted to make a large capacity bladder. The two ends of the bowel will be re-joined and will continue to function normally.

Before surgery is scheduled you will need to have video urodynamics studies to check bladder pressures and vesicoureteric reflux. These are baseline studies and will need to be repeated approximately 3 months following surgery.

Before surgery

  • Ensure your hospital paperwork is completed and sent to the hospital at least 7 days before surgery.
  • Ensure you have all your tests completed 4-7 days before surgery. These include bloods, ECG and urine test.
  • You will be admitted the day before surgery approximately 2PM to enable commencement of bowel preparation at 4PM.
  • Once admitted, you will be issued with anti-embolic stockings (compression stockings). You are required to wear these throughout your admission and at home up until the day you return to have your catheter removed.
  • If you are a Diabetic, please speak to the Practice Nurse at your earliest convenience.
  • If you are on any blood thinning medications, then please alert the nurse at your earliest convenience.
  • Please inform staff if you have any allergies.

Following your surgery

  • You will remain in hospital 10-14 days.
  • You will have intravenous fluids and you will not be allowed to drink until bowel sounds are heard. Once bowel sounds have returned, you will be commenced on sips of fluid and this will be increased if you are tolerating fluids well. Diet will be introduced once you are drinking free fluids.
  • Your urine output will be regularly monitored throughout your admission by nursing staff.
  • Recommencement of bowel routine will need to occur once you commence eating. The aim is to return you to your pre surgery bowel routine.
  • Your wound will have a waterproof dressing and this will be monitored and checked by nursing staff. Your sutures are dissolvable and your dressing will be removed approximately 7 days following surgery.
  • You will have a drain tube. This will be removed by nursing staff once drainage has stopped. This usually takes a few days.
  • If you have paraplegia, you will need assistance with transfers for the first few days.
  • Before discharge, you will be taught how to look after your catheters (urethral and suprapubic) and how to flush your suprapubic catheter. The bowel produces mucous. It is important you regularly flush you catheter to avoid mucous obstruction and to allow urine to flow freely. The hospital will advise you on procedure and frequency of flushes. Written instructions will be provided to you by the hospital.
  • You will be discharged with leg bags, sterile water/saline and Toomey syringes.
  • You will return to the hospital to have your catheter removed (Trial of void) approximately 3 weeks following surgery. The date for this will be given to you by the nursing staff on the day you are discharged.

Following discharge and before readmission to have catheters removed (Trial of Void)

  • It is normal to feel tired following surgery. It is important you get plenty of rest, eat a well-balanced diet and do gentle exercises such a walking. If you have paraplegia, it is important you limit your transfers and avoid any straining.
  • Ensure your bowels are regular. A high fibre diet with adequate fluids is essential. Avoid constipation as this may cause discomfort whilst the catheters are in place.
  • Sometimes mild laxatives are required. Speak to the Practice Nurse for further advice.
  • Take regular pain relief as required. Avoid codeine as this may cause constipation.
  • Your wound dressing will be removed before discharge. Your sutures are dissolvable and therefore will dissolve within 1-2 weeks. Please call the rooms if you notice redness, swelling and or discharge from the wound.
  • It is important you drink adequate fluids and to ensure your urine is pale yellow during the day and that the day and that you flush your suprapubic catheter as advised/taught.
  • You are required to have a urine culture taken before readmission. Instructions will be provided to you by the hospital before discharge. This test will check if you have a urinary tract infection. Antibiotics will need to be prescribed and taken at least two days before readmission to hospital if your culture is positive.

Readmission for Trial of Void

  • You will return to the hospital to have your catheters removed. This will be an overnight admission.
  • Your urethral catheter will be removed and you will be taught how to empty your bladder using intermittent catheters as you previously did before surgery.
  • The frequency of catheterisations will be determined by your doctor/nurse. The frequency of flushes will also be determined by your doctor and nursing staff. Generally, you should catheterize no less than 4 times per 24-hour period and up to 6-8 times if required.

Following discharge from your Trial of Void

  • You are advised to avoid heavy lifting for 6 weeks and any strenuous exercise or activities for 6 weeks. Strenuous exercise includes bike riding, running, horse ring and golf. Avoid stairs for the first few weeks.
  • If you have paraplegia, please limit the numbers of transfers.
  • Continue to have plenty of rest and eat a well-balanced healthy diet.
  • Drink 2 litres of fluid per day to ensure your urine is pale yellow and to help flush out your bladder.
  • Continue to pass your catheter as recommended by your doctor.
  • Return to work is dependent on the type of work you do. Generally being off work for 6 weeks is recommended. If you wish to return earlier you will need to discuss this with your surgeon.
  • No driving is allowed for 6 weeks.
  • You are required to return to the rooms for your first appointment following surgery approximately 4 weeks following removal of your catheters (Trial of Void). Please call the rooms if this appointment has not been made.

You must contact the rooms if you experience any of the following:

  • Redness, swelling and presence of purulent discharge from the wound
  • Fever, chills, sweats
  • Cloudy, offensive urine
  • Decreased or no urine output
  • Loss of appetite
  • Difficulty or inability to pass catheters