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In cases where all other treatment options have been unsuccessful in helping a person to manage their urinary incontinence, a cystoplasty (bladder enlargement) may be considered. Otherwise known as a bladder augmentation, this involves removing strips of tissue from the bowel, and adding it to the tissue of the bladder to enlarge it. This has 2 intended results: increasing the bladder volume to hold more urine and reducing the amount of bladder tissue that can contract, which will lower the pressure in the bladder during urination.

The risks of this surgery are that the bladder won’t completely empty, and you may need to insert a catheter to drain the remaining urine. Also, blockage of the bladder due to scar tissue where the bowel tissue has been attached.

Fig. 3: Bladder surgery to increase the size of the bladder.
Bladder surgery to increase the size of the bladder.

Urinary diversion
This should be considered only when all other treatments are not an option. Urinary diversion is a surgical procedure involves removing the bladder through an incision in the abdomen. Part of the intestines are then used to either create a new urethra or to create a new bladder. If a new urethra tube is created, it exits the body via a new opening in the abdomen called a stoma. A small urine disposal bag is placed over the stoma. The bag fits under your clothes and your doctor will teach you how to take care of and empty it as you will need to use urine disposal bags permanently afterwards.

If a new bladder is created, urine will pass out of the body as it did before, but it will feel different, and you will require a catheter and to wear pads in your underwear while you re-learn how to hold in urine and how to go to the toilet.

It is carried out under general anaesthetic as open surgery with an incision, or by laparoscopic or robotic-assisted surgery at specialist centres that offer this facility.

These types of surgery are considerably more invasive and are carried out by doctors with a lot of experience in this type of surgery. Should this type of surgery be recommended for you, there are potential long-term complications associated with having this type of operation, that your doctor will discuss with you in detail, should this type of surgery be recommended for you. Having an operation of this nature can also involve the life-long use of a catheter or urine disposal bags afterwards.