What is bladder augmentation?
A bladder augmentation (say: ogg-men-TAY-shun) is an operation to make the bladder bigger. A bigger bladder means it will be easier for your child to store and hold urine (pee). To make the bladder bigger, surgeons will remove a small piece of your child's bowel and attach it to the top of the bladder.
How the urinary system works
The urinary system gets rid of waste from the body. Two kidneys filter the body's blood. The waste made by your kidneys is called urine or pee. Urine travels from the kidneys to the bladder through a tube called a ureter. There is one ureter for each kidney.
The bladder is a muscular bag that can stretch to hold urine. A strong muscle at the bottom of the bladder stops the urine from coming out until you are ready to use the toilet. This muscle is called a sphincter. When the bladder is full, it sends a message to the brain, telling it that it is time to go pee. Then the sphincter relaxes and sends the pee out through the urethra. The urethra is the opening either at the tip of the penis (in boys) or above the vagina (in girls).
When a child has a small bladder
Because your child's bladder is so small, it fills very quickly and sends messages to the brain more often than normal. As your child's bladder fills up, pressure also builds up in the bladder. This pressure can make it hard for your child to hold the pee in. Your child's bladder needs more room so that it can store urine for a longer time.
Talk to your child about the operation
Once you have read this page and have spoken to the doctors about your child's operation, speak to your child. Using words that they will understand, explain what the surgery is for and what is going to happen. When children know what to expect, they are usually less anxious and more cooperative.
Many hospitals have pre-admission programs meant for children. These programs let parents and kids know what to expect. It is a good idea for parents and children to participate in these programs before any operation. Ask the nurse at the urology clinic about these types of programs for children.
Preparing the bowel before the operation
Your child's bowel needs to be as clean as possible before the surgery. This preparation takes about three days. Most families choose to do the first two days at home and then come to the hospital for the last day. A urology nurse will meet with you to describe how to prepare the bowel at home.
Eating and drinking
For two to three days before the operation, your child should only have clear fluids to drink. Clear fluids are liquids you can see through, like water, apple juice, ginger ale, Sprite, Jello and freezies. Your child cannot have anything else to eat or drink.
Write the date of your child's operation here:
Write the date your child must start having only clear fluids here:
Enemas
Your child will need to have several enemas. An enema means that a small tube is put into your child's anus and water is flushed inside. Then, your child will go to the bathroom and expel the water and feces (poo) from the bowel. Usually, enemas are a bit uncomfortable but they do not hurt.
Coming to the hospital
On the day before the surgery, your child will come to hospital and be admitted to the unit. The nurses will keep on preparing your child's bowel for the operation. They may give your child laxatives and enemas to clean out the bowel.
Your child will also get an intravenous (IV) tube in the arm while they are in hospital. This is used to give your child liquids, foods and medicine.
Before the operation
The nurse will take a small amount of blood from a vein in your child's arm, using a small needle. If your child is afraid of needles, you can encourage them to do deep breathing. This will help your child stay calm and it will reduce pain.
Your child will have a special "sleep medicine" called a general anesthetic before the operation. This will make sure that your child will sleep and feel no pain during the operation.
During the operation
The operation takes between about three to seven hours. It depends what kind of operation the surgeon uses. The surgeon will explain this to you before the operation.
After the operation
Your child is taken to the Post-Anesthetic Care Unit, or the hospital's recovery room. In a few hours, your child will become more awake. Then they will be taken to the urology unit.
Your child will have an IV tube in the arm. This lets the doctors and nurses give your child liquids, food and medicine. Your child will not be eating through the mouth for about a week. This gives your child's bladder and bowel time to heal.
Your child will also have a nasogastric (NG) tube. An NG tube is a small hose that is put into your child's stomach through the nose. The tube keeps your child's stomach empty. Your child will still be able to breathe normally while the NG tube is in place. After a few days, the tube is removed and your child can start eating by mouth again.
Your child will have some stitches on their tummy. The stitches keep the incision site closed so it can heal. The incision site is where the doctors cut the skin to do the operation.
Your child will also have a few tubes on their tummy. These may include a suprapubic catheter, a foley catheter and a Penrose drain. The foley catheter and the Penrose drain will be removed before your child goes home. The suprapubic catheter will be removed later at a follow-up appointment at the urology clinic.
Pain management after the operation
Your child's tummy will be sore after the operation. Pain medications will be given as needed. If you see your child in pain, please speak to the nurse about pain medication.
You can help your child cope with pain by using deep breathing and by distracting your child. Ask the nurse how you can help. Your child will have to stay in the hospital for a few days. A child life specialist can help keep your child busy with toys and games.
While your child is in bed, it is important to exercise the lungs. One way is to take slow, deep breaths and then cough. Your nurse will show your child how to do this.
Learning to use the bladder again
After the operation, your child will have a tube called a suprapubic catheter. This takes urine (pee) from your child's bladder to the outside of the body. It will be taken out when your child is comfortable peeing or self-catheterizing.
Sometimes after the operation, your child's urine may have some mucus in it. Mucus looks white and thick, and it may block the suprapubic catheter. To keep the suprapubic catheter clear, you will need to irrigate your child's catheter every day. Your nurse will show you how to do this before your child goes home.
After a few days, your child will be able to start peeing normally again. At first, your child may not have full control of their bladder. Your child may also have bladder spasms and cramping. If this becomes a problem, your child may need to take medicine to reduce these symptoms.
Sometimes your child's bladder will need help to empty properly. This is done with a small tube, called a catheter, that is put through the urethra into the bladder to drain the urine. This is called self-catheterizing. Your nurse will explain how to do this.
Going home after about a week
When your child is well enough, they can to go home from the hospital. You will need to bring your child back to the hospital for a follow-up appointment. If you are not given a date for this appointment, please ask the nurse.
Write down the date and time of the appointment here:
At SickKids
Supporting your child
When preparing your child for an operation, the urology team recommends that whenever possible, your child and family members attend the Pre-Admission Program offered at SickKids.
A child life specialist can also help to prepare and support your child if they are anxious about the operation.