What does the procedure involve?
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 are the alternatives to this procedure?
Observation, bladder training, pelvic floor exercises, drugs, injections into the bladder, urinary diversion, sacral nerve stimulation.
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, 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 be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg 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.
What happens immediately 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.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
You may develop diarrhoea/vitamin deficiency/constipation due to shortened bowel, requiring treatment. Bowel and urine leakage from the anastomosis, requiring re-operation, can occur. Similarly you may develop scarring of the bowel or ureters requiring further surgery. There is a risk of developing recurrent urinary infections, requiring long-term antibiotic treatment.
Some patients need to self-catheterise because the enlarged bladder will be unlikely to empty fully after the procedure. The function of the kidneys may decrease with time. You may pass mucus in the urine which can cause intermittent blockage of the urinary stream.
Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) can occur at the time of surgery.
Follow-up telescopic examinations of the bladder under local anaesthetic will begin at between 5 and 10 years after surgery to check for the bladder remains healthy.
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
You will require pain-killing tablets at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile.You may go home with one or both catheters still in place, and have a planned return to hospital for these to be removed. If so, you or your carers will be taught how to look after the catheters and the drainage systems for them.
You should avoid driving for at least six weeks, and it may be longer before this is possible. If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity. Heavy lifting should be avoided for 6 weeks. Sexual intercourse should be avoided for at least a month. You may see blood in the urine or vaginal discharge for up to a month after surgery.
What else should I look out for?
If you go home with catheters, you or your carers should check regularly to ensure that urine is draining via the catheters, which confirms that the catheters have not blocked. If the catheters both become blocked this could put pressure on the suture line in the bladder, and so the catheters would need to be flushed and unblocked very promptly.
Are there any other important points?
The Urology Specialist Nurses will keep in contact by phone and by clinic visits in the first couple of months after surgery, and be available for long-term follow-up. A follow-up outpatient appointment will be arranged at about 10-12 weeks after surgery.
