Surgery For Over Active Bladder
Overactive bladder (OAB) is a common condition that causes a person to feel a strong need to urinate. This can cause embarrassing symptoms and interfere with daily life.
Overactive bladder usually responds to less-invasive treatments such as fluid and dietary changes, pelvic muscle exercises and medications. However, as a last resort surgery may be used to relieve severe symptoms.
Urinary Diversion Surgery
A surgical procedure for over active bladder is called urinary diversion. This surgery diverts urine from the bladder to an ostomy (bag) on the outside of your body.
This type of diversion is most often done after cystectomy, a surgery that removes the bladder in men and some of the pelvic tissues in women. A simple cystectomy only removes the bladder, while a radical cystectomy may include the removal of the prostate, seminal vesicles and uterus in men and part of the vagina in women.
The surgeon uses a piece of the small intestine to create a tube (conduit) that connects one or both ureters previously connected to your bladder. Urine drains into this conduit, passes outside of your body through a hole in the wall of your abdomen (stoma), and fills a pouch that you wear under clothes.
There are many different types of urinary diversion surgery, each with a different complication rate and different risks for infection. Regardless of which type of diversion you have, your surgeon will help you understand how to care for the new area of your urinary tract that is outside of your body.
Augmentation Cytoplasty
Augmentation Cytoplasty (AC) is an operation that is used to treat neurogenic bladder dysfunction. It involves enlarging the bladder using a piece of tissue from the bowel, such as the small or large intestine, or the ureters.
The procedure is done under anaesthesia and lasts for about three to four hours. Once the surgery is finished, your doctor will put a tube called a catheter into the bladder.
After your surgery, you'll need to self-catheterize frequently to empty your bladder. You may have to catheterize up to 4-5 times a day for the rest of your life.
You will also need to irrigate your bowel's mucus regularly, to keep it from clogging your catheter and causing blockages that can lead to other health problems. It also increases the risk of developing UTIs.
Every surgery has a small risk of complications. Complications after bladder augmentation include bleeding, fistula, and perforation of the bowel. They can be serious and life-threatening.
Bladder Removal Surgery
If you have over active bladder, there are several treatment options to help relieve the symptoms. They include changing certain behaviors, medications and nerve stimulation (neuromodulation).
Medications and behavioral changes can help control OAB and improve your quality of life. However, they are not a cure for the condition.
In some cases, surgery is the best option for treating over active bladder. This may include creating a new way to wee, such as a stoma or neobladder.
To create a neobladder, your surgeon takes part of a section of your small intestine. It hooks up to your urethra and allows you to pee just as before, but without normal muscle reflexes that kick in when the bladder is full.
After surgery, you’ll stay in the hospital for a week or more to ensure that your new urinary evacuation system works correctly. Depending on which type of cystectomy you have, you may have to wear an appliance bag to catch urine until the stoma heals and you can self-catheterize. Doctors also recommend using reusable incontinence products to avoid leakage on clothing and furniture.
Nerve Stimulation Therapy
There are several different treatment options for over active bladder, including sacral neuromodulation and percutaneous tibial nerve stimulation (PTNS). Both of these procedures aim to improve your ability to control your bladder by targeting the sacral nerves.
SN involves surgical implantation of electrodes to stimulate the sacral nerve roots in the lower back. It is considered successful when pain is reduced by at least half and patients report improvements in their quality of life.
TENS uses a battery-powered device to send small electrical impulses through electrodes placed on the skin surface, usually the tibial nerve near your ankle. The impulses can decrease pain signals and promote blood flow to the muscles and other areas.
PTNS is a drug-free option for treating overactive bladder symptoms. It requires 12 consecutive treatments to get optimum results and is recommended once a month to maintain symptom relief.
