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Bladder Augmentation and Incontinence Surgery

Some children are born with or develop bladders that do not function properly. These children may have a history of myelomeningocele (spina bifida), bladder exstrophy or bladder obstruction. If medication and clean intermittent catheterization (CIC) do not prevent leakage of urine or high bladder pressure that may damage the kidneys, bladder augmentation with or without other types of surgery to stop incontinence may be recommended.

What is bladder augmentation?

This is a procedure in which a piece of the bowel, stomach or ureter (the tube that carries urine from the kidney to the bladder) is used to enlarge the bladder. This allows the bladder to hold more urine at lower pressure.

What other types of surgery are used to stop urinary leakage?

Sometimes bladder augmentation is not needed or is not enough to prevent urinary leakage. In these cases, the incontinence can be stopped in one of two main ways:

Procedures to tighten the urethra:

The urethra can be tightened by using a piece of tissue that is present in the abdominal wall (called fascia) to surround the urethra. Another way to stop leakage is to place an artificial sphincter around the urethra. The sphincter is activated by pumping a valve that is placed in the scrotum in boys or labia in girls. This causes water to fill up the sphincter and gently compress the urethra, preventing leakage. In some cases, the appendix, part of a ureter or a fallopian tube can be transferred down to replace the urethra. The tissue is then sewn into the bladder so that no leakage can occur. At this point, the bladder can only be emptied by catheterization (CIC). This is called a Mitrofanoff procedure.

Continent diversion:

In some cases it is necessary or helpful to bring a channel to the skin for a child to catheterize through instead of using the urethra. This channel may be made up of appendix, ureter, a piece of bowel or fallopian tube. The channel is designed to prevent leakage and usually exits at the belly button.