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Information for Parents

Bladder Augmentation and Mitrofinoff in Children

  • What is this disease?

    • Bladder augmentation (also known as a cystoplasty) is an operation to enlarge the bladder using a  part of  large or small intestine, but the ureters or even the stomach can be used. After the operation, the bladder will not be able to squeeze and empty normally as it does not contain sufficient muscle. If the intestines (either small or large) have been used, the tissue will also produce mucus. This means that all or some of the urine in the bladder must be emptied with a tube called a catheter. The catheter can be passed either through the urethra or through a specially created channel called a Mitrofanoff (continent catheterisable channel)

  • How is it diagnosed/when this procedure is needed in children?

    • Conditions that might require bladder augmentation include:  Bladder and cloacal exstrophy, Spina bifida and other spinal defects(Neurogenic Bladder), Posterior urethral valves, Anorectal anomalies , Non-Neuropathic Neuropathic Bladder(Hinman’s syndrome or other form) and other causes.

  • How it is treated?

    • Bladder augmentation is recommended in  above mentioned conditions in children  whose bladder capacity is small, leading to frequent voiding or wetting( Incontinence), or high pressure in bladder. This high pressure can lead to leakage or can damage the Kidney. It is also useful in prevention of urine infections.

  • When it should be operated or recommended?

    • Augmentation enterocystoplasty with cutaneous continent catheterizable should be performed before renal damage had started and is  technically feasible and safe in preschool-aged children also. However, the ideal age for augmentation remains unknown and would vary  according to severity of disease.

  • Are there other alternative methods of treatment?

    • Alternatives to the operation, includes medicines such as oxybutinin, other minor procedures such as injection of bulking materials into the bladder neck or intermittent catheterisation. Bladder augmentation tends to be suggested when these alternatives have not been successful, and child has started to show signs of renal damage or is socially incontinent.

  • What all I need to know before my child surgery?

    • Read “All you need to know before your child's surgery” information booklet in website.

  • How is the surgery done?

    • The operation is carried out under general anaesthetic and included opening up the bladder to form a cup followed by disconnecting ureter and then re-implanting it so that  they can drain properly. Then a piece of intestine  is removed and also shaped into a cup-shape and joined to the top of the bladder to close it. The Mitrofanoff is usually made out of the appendix. The surgeon disconnects the appendix from the large intestine while keeping its blood supply intact and opens one end to form a tube. One end of the tube is tunneled through the bladder wall and the other is joined to a small opening in the surface of the skin.

  •  Remarks

    • For more details of surgery, contact your surgeon

  • Related Photographs and videos

    • Few photographs of steps done by me  is given here for learning purposes

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