Let's learn about bladder enlargement surgery (Augmentation Cystoplasty) in simple terms.

Do you have a constant urge to urinate? Or do you have times when you can't control even a little urine, and it leaks onto your clothes? For some people, this can be a big obstacle in their daily lives. When the bladder is not functioning properly due to certain medical conditions, this can lead to problems like this. So, in times like these, one solution that doctors suggest is bladder enlargement surgery. That's what we're talking about today.

What is this bladder enlargement surgery (Augmentation Cystoplasty)?

Simply put, your bladder is a sac-like organ that can hold urine for a while. This surgery makes your bladder a little bigger. That is, it increases its capacity.

Imagine that the water bottle you have is small, so you have to fill it up frequently. If we attach another piece to that bottle and make it bigger, can we put a lot of water in at once? Well, that's what happens with this surgery.

Doctors use a part of your own body for this procedure. To be precise, they take a small piece of your own small intestine or large intestine and attach it to your bladder to enlarge it. If the small intestine is used, it is called an ``ileocystoplasty'', and if the large intestine is used, it is called ``sigmoid or ceco-cystoplasty''. But this is not so important to you. The important thing is that this makes your bladder bigger and can hold more urine.

Why is it necessary to have this kind of surgery?

Not everyone needs this surgery. It is often recommended for people who have impaired bladder function due to specific medical conditions. For example:

• Spinal cord injuries: When the spinal cord is damaged due to an accident, the nerves that control the bladder can be affected.
• Congenital neurological disorders: Some babies are born with certain problems with their spine or nervous system.
• Other medical conditions: Diseases such as ``Multiple Sclerosis'' can also cause changes in bladder function.

These reasons can cause various problems with the bladder. Let's see what they are.

Most often, this surgery is performed on people who have been using self-catheterization for a long time. This is a procedure in which a thin tube (catheter) is inserted through the urethra to empty the bladder. If this method does not resolve the problem, your doctor will tell you about this surgery as the next step.

What happens before the surgery?

Since this is a major surgery, it cannot be done all at once. The doctor will examine you thoroughly to see if you are suitable for this. He will do several tests like this.

• Physical exam: Your general health is checked.
• Blood tests: Check kidney function and whether there are any infections.
• X-rays: Take a picture of the urinary system.
• Cystoscopy: A test in which a tube with a small camera is inserted through the urethra to look inside the bladder.
• Urodynamic testing: A special test that measures how the bladder functions and the pressure it exerts when it fills and empties.

What happens during the surgery?

The surgery is performed under general anesthesia (sleeping) so you won't feel anything. The surgeon can perform this surgery in two ways: either through a single long incision in the abdomen (open surgery), or through several small incisions using robotic surgery.

Anyway, the basic steps are as follows:

1. First, the surgeon cuts open the top of the bladder .

2. Then, a piece of the prescribed size is cut and separated from the small intestine or large intestine, as previously determined.

3. The separated piece of intestine is folded down the middle, forming a flat "patch".

4. Finally, this piece of intestine is placed into the previously opened bladder, and the two are connected and sewn together .

After this procedure, the bladder will be larger than before. When you wake up after the surgery, you will see two or three tubes sticking out of your abdomen and bladder. These are inserted to allow urine to drain and to flush the bladder until the new bladder heals. Don't worry, these are temporary.

Typically, this surgery can take between two and six hours .

What happens after the surgery? How long does it take to recover?

The recovery period after surgery is also very important. Your dedication is needed during this time.

Time in the hospital

Usually you will have to stay in the hospital for about five to seven days .

• Food and drink: You will not be allowed to eat or drink for the first few days. This is because after a surgery like this, the bowels temporarily stop working and become "sluggish". We call this ``ileus''. This is normal. You may also need to have a tube inserted through your nose to drain the fluids in your stomach. Once your bowels start working again, you will be given liquid foods (such as soup) at first, and then gradually introduced to regular foods.
• Tubes: While you are in the hospital, you will have several tubes in your abdomen. At least two tubes are inserted to drain urine from your bladder. The nursing staff will teach you how to care for these tubes, especially how to rinse out mucus that collects in your bladder (irrigation).

Long-term care after going home

• Mucus Irrigation: If this mucus builds up, it can block the urethra, cause urinary stones, and lead to infections. Therefore, you will need to flush the inside of your bladder with a special solution every morning for the rest of your life. You will be taught how to do this in the hospital.
• Tests: About three weeks after surgery, you will have an imaging test to make sure your new bladder is not leaking urine. If everything is healing well, your doctor will remove your tubes.
• Self-Catheterization: After the tube is removed, you will need to start self-catheterizing yourself. Don't worry! The medical team will teach you how to do this until you can do it on your own with ease.

What are the benefits and risks of this surgery?

Like any surgery, this one has benefits as well as some risks.

What are the advantages?

If this surgery is successful, it could bring great relief to your life.

• As the bladder gets bigger, the pressure inside decreases .
• This stops or reduces damage to the kidneys .
• Because you can hold more urine at once, you won't need to urinate as often .
• Usually, you can go without urinating for at least four hours .
• Being able to control your urine gives you a lot of confidence when you're out in public.

Risks and complications

The mucus removal we discussed earlier can cause major problems if not done properly. In addition, there are some risks inherent to the surgery itself.

How long will it take to fully recover?

This is a process that takes a while.

• After about six weeks , you can expect to be largely back to normal. That means you'll feel about 90% better.
• However, it may take about three months to fully recover to the same level as before the surgery.
• During this time, you should completely avoid anything that puts pressure on your abdomen, such as lifting weights, running, playing sports, and having sex .
• You can return to work or school after about six weeks, depending on the nature of your job and the speed of your recovery.

At what point do you suddenly need to call the doctor?

If you experience any of the symptoms below after you return home, you should call your doctor immediately or go to the Emergency Department (ETU) of your nearest hospital.

• If there is excessive bleeding around the cut.
• If the fever is over 100 degrees F (38 C).
• If the wound area becomes red, swollen, painful, or oozing pus (signs of infection).
• If you cannot insert the urethral catheter or it feels stuck.

Your doctor will keep scheduling clinic appointments for you. Initially, he will ask you to come in to check the wound, cut the stitches, and remove the tubes. After that, he will ask you to come in about once a year to check the condition of your kidneys, have blood tests, and renew your tube prescription.

This surgery is a life-changing decision. Therefore, be open and honest with your doctor about all your concerns and fears. This will help you navigate this journey.