Dr. Sean Elliott, MD
Reconstructive Urologist
Bladder reconstruction for neurogenic bladder
Bladder augmentation (enlargement) by adding a patch of small intestine.
A bladder augmentation both enlarges the volume of the bladder and lowers the pressure of the bladder. The most common reason to do this surgery is that a bladder has grown small and high-pressure from a neurologic problem like spinal cord injury or spina bifida. The bladder augment can correct urinary incontinence, bladder infections and kidney damage, all of which can happen due to a high pressure bladder.
After a bladder augmentation the bladder will be so low pressure that the person will need to self-catheterize in order to empty the bladder. It will not be possible for them to urinate naturally through their urethra. But, most people who need a bladder augmentation are already using a catheter to empty their bladder, so this isn’t much of a change.
Kidneys
Ureters
Figure 1.
Figure 2. A segment of small intestine is cut twice to separate it from the rest of the intestine.
Colon/large intestine
Small intestine
25 cm
Appendix
Appendix
Small intestine
Appendix
Colon/large intestine
Small intestine
Colon/large intestine
25 cm
25 cm
Figure 3. Open end of intestine tube allows you to see the inside, shown in pink.
Figure 4. Intestine is reconnected.
Isolated segment of intestine is opened lengthwise and reconfigured as a square.
Figure 6. The opened tube of intestine is now a rectangular flat piece of intestine and we are looking at the inside (in pink).
Figure 5. Intestine is opened lengthwise.
Figure 7. The flat piece of intestine is folded into an “S” shape.
Figure 8. The inside edges of the “S” are sewn together, converting the “S” into a square.
Figure 9. Open the bladder.
Figure 10. Bring augment down to bladder.
Figure 11. Sew bottom of augment to back wall of open bladder.
Figure 12. Fold the top of the augment over so that it will make a dome-shape to add to the size of the bladder. The inside of the intestine is shown in pink, and the outside in light brown.
Figure 13. Sew the top of the augment to the front wall of the opened bladder.
Figure 14. If someone cannot catheter through their own urethra then we can make a Mitrofanoff at the same time as the bladder augmentation. That way, they can catheterize through their abdominal wall. This is especially helpful for people who use a wheelchair..
Kidneys
Ureters