Bladder augmentation (augmentation cystoplasty)
Surgery that makes a small or stiff bladder larger and softer by sewing a patch made from your own bowel onto it. Many people also get a small channel from the bladder to the belly button for passing a catheter, called a Mitrofanoff.
Also called augmentation cystoplasty, augmentation ileocystoplasty, enterocystoplasty, clam cystoplasty, bladder augment, making the bladder bigger, bladder enlargement surgery, bowel added to the bladder
- Where
- Hospital operating room
- Anesthesia
- General anesthesia, often with an epidural or nerve block for pain control
- Time in the room
- About 4 to 6 hours, longer if a catheter channel is made
- Hospital stay
- Usually 4 to 7 days
- Going home with
- A tube through the lower belly into the bladder (suprapubic catheter), and often a catheter in the new channel or the urethra, usually for about 3 to 4 weeks
- Back to normal
- About 6 to 8 weeks
- Back to work
- About 4 to 8 weeks, longer for physical jobs
Overview
Some bladders become small and stiff. They hold little urine and build up high pressure as they fill. High pressure can push urine back up toward the kidneys and slowly damage them, and it causes leaking between catheterizations. Bladder augmentation enlarges the bladder by opening it and sewing on a patch made from a piece of your own bowel, most often the small bowel (ileum).
The new, larger bladder holds more urine at low pressure. The bowel patch does not squeeze the way bladder muscle does, so nearly everyone who has this surgery empties the bladder with a catheter for the rest of their life, usually every 4 to 6 hours during the day. This is the most important thing to understand before you decide.
Many people also have a Mitrofanoff channel made in the same operation. The surgeon uses the appendix (or, if there is none, a small tube made from bowel, called a Monti channel) to connect the bladder to a tiny opening in the belly button or lower belly. This lets you or a caregiver pass a catheter while sitting in a wheelchair, without having to reach the urethra.
The surgery is usually done through an open cut on the lower belly, and some centers do it robotically. It is a major operation with lifelong follow-up, because bowel tissue in the urinary tract brings its own long-term issues: mucus, stones, infections, and changes in blood chemistry. Many people who have it were born with spina bifida, and some have it as children or teenagers. If this is for your child, the same steps apply.
The parts of your body involved
The bladder is a muscular bag that should hold urine at low pressure until you choose to empty it. In some nerve conditions, and after scarring from radiation or infection, the bladder wall thickens and stiffens into ridges and holds less. The small bowel (ileum) is a long tube with a rich blood supply that hangs from a fan of tissue called the mesentery. A short piece can be taken with its blood supply, opened flat, and used as a patch, while the rest of the bowel is joined back together. The appendix is a thin tube off the large bowel that can become the catheter channel.
- Bladder
In people who need this surgery, the bladder is usually small, thick-walled, and stiff, so pressure rises quickly as it fills.
- Ileum (small bowel)
The last part of the small bowel. A short piece makes the patch. Your bowel is joined back together and keeps working.
- Mesentery
The fan of tissue that carries blood vessels to the bowel. The patch keeps its own blood supply through it.
- Appendix
A small finger-like tube off the large bowel. It can be moved to make the catheter channel.
- Ureters
The tubes that carry urine from the kidneys to the bladder. High bladder pressure can back up into them.
- Urethra and bladder neck
The outlet of the bladder. If it is weak and leaks, it may need to be tightened or closed in the same operation.
Why it’s done
Augmentation is used less often today than in the past, because Botox injections and medicines help many people. Your doctor may recommend it when other treatments have not kept bladder pressure safe or kept you dry, and when you are able and willing to catheterize for life, either yourself or with a reliable caregiver. The AUA and SUFU guideline on neurogenic bladder supports augmentation for carefully chosen people when less invasive treatments fail.
- Protecting the kidneys
High pressure in the bladder, urine backing up toward the kidneys, swelling of the kidneys on ultrasound, or worsening kidney blood tests.
- Leaking between catheterizations
A bladder that holds too little leaks even when you catheterize on schedule.
- Botox and medicines no longer working
When injections and pills cannot keep the bladder soft and large enough, or cause side effects you cannot live with.
- A bladder shrunk by scarring
Radiation, tuberculosis, or other inflammation can leave a small, stiff bladder that holds very little.
- Making catheterization possible
A Mitrofanoff channel helps people who use a wheelchair, cannot easily reach the urethra, or find urethral catheterization painful.
Other options
- Medicines and catheterization
Bladder-relaxing medicines combined with regular catheterization keep many bladders safe without surgery.
- Bladder Botox injections
Injections into the bladder wall every 6 to 12 months can lower bladder pressure and reduce leaks for many people with neurogenic bladder.
- Indwelling or suprapubic catheter
A catheter that stays in all the time, through the urethra or the lower belly, drains the bladder continuously so pressure stays low. Simpler, but with its own long-term problems such as infections and stones.
- Ileal conduit urinary diversion
Urine is rerouted through a short piece of bowel to an opening on the belly and collected in a bag. This can suit people who cannot catheterize. The conduit itself is described on the cystectomy and ileal conduit page.
- Continent pouch
For some people, a new reservoir made from bowel with a catheter channel replaces the bladder instead of enlarging it.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia and positioning
You go to sleep under general anesthesia and lie flat on your back. The skin of the belly is cleaned and covered with sterile drapes. A catheter is placed in the bladder.
After the operation
In the hospital
- Pain control
An epidural or IV pain medicine keeps you comfortable for the first days, then you switch to pills.
- Eating again
Your bowel needs time to wake up after it has been operated on. You start with sips and move slowly to food as you pass gas, usually over a few days.
- Bladder washouts
The bowel patch makes mucus. Nurses rinse the bladder through the catheter several times a day to keep the tubes from clogging, and teach you or your caregiver to do it.
- Walking
You get out of bed on the first day after surgery. Walking speeds bowel recovery and prevents clots.
- Drain removal
The drain usually comes out after a few days, once the fluid slows down.
- Blood tests
Blood salts and kidney function are checked while you are in the hospital.
- Going home
You go home when you are eating, walking, comfortable on pills, and confident with tube care and washouts. Some people go to a rehabilitation unit first.
At home
- Pain
Soreness at the incision improves week by week. Use the medicine you were prescribed and switch to acetaminophen as soon as you can.
- Tubes
The suprapubic tube and channel catheter usually stay for about 3 to 4 weeks. Keep them draining freely into a bag, with no kinks, and keep the bag below your bladder.
- Washouts
Rinse the bladder with sterile salt water as taught, often daily or more at first, to clear mucus.
- Fluids
Drink enough that your urine is pale. Plenty of fluid thins the mucus and lowers the risk of stones and infection.
- Wound care and showering
Most people can shower after a couple of days. Pat the incision dry. No baths or swimming until your surgeon says the wound has healed.
- Diet and bowels
Eat small, frequent meals at first. Bowel habits may change, and stools can be looser for a while. Tell your team if diarrhea does not settle.
- Activity and lifting
Walk every day. Do not lift more than about 10 to 15 pounds (4.5 to 7 kg) for about 6 weeks, to protect the incision and prevent a hernia.
- Driving
Do not drive while taking opioid pain medicine. Most people drive again after about 2 to 4 weeks.
- Starting to catheterize
At about 3 to 4 weeks, an X-ray with dye (cystogram) checks that the bladder has healed. Then the channel catheter comes out and you begin catheterizing, at first every 2 to 3 hours, gradually stretching to every 4 to 6 hours. The suprapubic tube is often kept a little longer as a backup.
- Sex and work
Sex is usually fine after about 6 weeks. Return to work depends on your job, often 4 to 8 weeks.
Recovery timeline
- Day 0Surgery
You wake up with an epidural or IV pain medicine, a drain, and several tubes.
- Days 1 to 3Up and walking
Walking, sips of fluid, and frequent bladder washouts by the nurses.
- Days 4 to 7Going home
Eating, drain out, home with tubes and washout supplies.
- Weeks 2 to 3First check
Clinic visit to check the incision and remove staples if you have them.
- Weeks 3 to 4Tubes out, catheterizing begins
A cystogram confirms healing. You begin catheterizing on a schedule.
- Weeks 6 to 8Back to normal activity
Most people are back to normal daily life and can begin lifting.
- About 3 monthsChecking the new bladder
Ultrasound, blood tests, and sometimes urodynamic testing confirm low pressure and healthy kidneys.
- Every year afterLifelong follow-up
Yearly blood tests (salts, kidney function, and vitamin B12 over time), kidney and bladder imaging to check for stones and swelling, and, after many years, discussion of cystoscopy checks.
What it feels like
This is a big operation, and it changes daily routines for good. Most people who choose it have already lived with catheters, leaking, or kidney worries for years, and many describe a mix of fear and hope going in. The first weeks with tubes, mucus, and washouts can feel overwhelming. Most people find the routine becomes second nature within a few months.
Waking up
A sore belly, tubes and bags in several places, and grogginess. It can be a shock to see.
What helpsAsk the nurse to name each tube and explain what it does. The epidural or pain pump is there to be used.
When the bowel wakes up
Bloating, nausea, and frustration at how slowly eating comes back. Passing gas for the first time is a real milestone.
What helpsWalk as much as you can, and move to food slowly as your team advises.
Seeing mucus
Thick, cloudy strands in the urine look alarming the first time.
What helpsIt is expected with a bowel patch. Washouts and plenty of fluid keep it manageable.
Going home with tubes
Worry about managing bags, washouts, and tubes without nurses nearby.
What helpsAsk for a home nursing visit, a written checklist, and a number to call day or night.
The first catheterization through the channel
Nervous about whether it will go in and whether it will hurt. Most people feel little, because the channel has little feeling.
What helpsUse plenty of lubricant, relax, and go slowly. A nurse is usually with you the first time.
Waking up dry
For many, the first dry nights in years bring deep relief.
What helpsKeep to your catheter schedule even when you feel fine. Missed catheterizations can be dangerous with an augmented bladder.
The long haul
Remembering to catheterize every few hours and keeping up with yearly tests can feel like a lot.
What helpsPhone alarms, a set routine, and spare supplies in your bag, car, and workplace make it easier.
How well it works
Success means a bladder that holds more urine at low pressure, kidneys that stay healthy, and staying dry between catheterizations. Most people who have augmentation reach these goals, and many describe a large improvement in daily life. Results are measured with urodynamic tests, kidney ultrasounds, and blood tests over many years.
- Capacity and pressure
Urodynamic testing a few months after surgery shows how much the bladder holds and whether the pressure stays low.
- Kidney health
Kidney ultrasounds and blood tests show whether swelling has improved and kidney function is stable.
- Dryness
Most people are dry between catheterizations. Some still leak from the urethra and may need another procedure to tighten the bladder outlet.
- Lifelong check-ups
Yearly blood tests, imaging for stones, and, after about 10 years, a discussion about cystoscopy checks. Practice varies between centers.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Nearly everyone with a bowel patch makes mucus. Regular washouts keep it from blocking the catheter.
Bacteria in the urine are almost universal and usually harmless without symptoms. Infections with fever or pain are common and need treatment.
Mucus and bacteria can form stones over the years. They are usually removed with a scope or a small procedure.
The channel opening can narrow, the catheter can become hard to pass, or the channel can leak. Some channels need a revision over time.
Looser stools or more frequent bowel movements, usually manageable with diet or medicine.
Less common
The bowel patch can absorb acid and salts from urine. Blood tests often show mild changes. Some people need bicarbonate tablets, and long-standing acid buildup can weaken bones.
The augmented bladder can burst if it is overfilled, most often when catheterizations are missed. This is a life-threatening emergency that needs urgent surgery.
Can develop years later because a piece of bowel was used. Checked with blood tests and treated with B12.
May need another procedure to tighten or close the bladder outlet.
Scar tissue inside the belly can kink the bowel, months or years later.
Infection or a bulge at the incision.
Rare
Early after surgery. May need drainage or another operation.
Rare, and usually only after 10 or more years. This is part of the reason for lifelong follow-up.
Prevented with walking, leg sleeves, and blood-thinning injections.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Belly pain that keeps getting worse, a hard swollen belly, or feeling very unwell, especially if you could not drain your bladder (possible rupture: go to the emergency room)
- You cannot pass a catheter and drain your bladder, and you are past your usual time (go to the emergency room if you cannot reach your team)
- Mucus blocking the catheter that does not clear with a washout
- Vomiting, no gas or stool, and a swollen belly (possible bowel blockage)
- Thick blood or clots in the urine that block the catheter
- Redness, pus, or opening of the incision
- Leg swelling or pain, chest pain, or shortness of breath (call 911 for chest pain or trouble breathing)
Questions to ask your surgeon
- Why is augmentation a better choice for me than continuing Botox or medicines?
- Will you make a catheter channel, and where will the opening be?
- Will you use my appendix, or make a Monti channel?
- How much bowel will you use, and how might it change my bowel habits?
- Do I need my bladder outlet tightened or closed too?
- Will the operation be open or robotic?
- How often will I need to catheterize and wash out my bladder?
- What blood tests and scans will I need each year, and for how long?
- Will I need cystoscopy checks in the long run?
- How many of these operations does your team do each year?
- If pregnancy is possible for me, what should I know?
Words you may hear
- Augmentation cystoplasty
- Surgery that enlarges the bladder with a patch of bowel.
- Ileum
- The last part of the small bowel, the most common source of the patch.
- Mesentery
- The fan of tissue that carries blood vessels to the bowel.
- Detubularize
- To open a tube of bowel flat so it cannot squeeze in waves.
- Mitrofanoff
- A narrow channel, usually made from the appendix, that connects the bladder to a small opening on the belly for catheterization.
- Monti channel
- A catheter channel made from a short piece of small bowel when the appendix cannot be used.
- Stoma
- The small opening on the skin where the channel comes out.
- Clean intermittent catheterization
- Passing a catheter to drain the bladder, then removing it, several times a day.
- Bladder washout
- Rinsing the bladder with sterile salt water through a catheter to clear mucus.
- Bladder compliance
- How easily the bladder stretches as it fills. Low compliance means a stiff, high-pressure bladder.
- Metabolic acidosis
- Too much acid in the blood, which can happen when bowel absorbs substances from urine.
- Urodynamics
- Tests that measure pressure and volume in the bladder as it fills and empties.
- Cystogram
- An X-ray of the bladder filled with dye, used to check for leaks.
- Neurogenic bladder
- Bladder problems caused by a nerve condition such as spina bifida, spinal cord injury, or multiple sclerosis.
- Perforation
- A tear or hole in the bladder wall.
Common questions
Will I ever urinate normally again?
Almost never. Nearly everyone with an augmented bladder needs to catheterize for life, because the bowel patch does not squeeze.
Can I still catheterize through my urethra?
Yes. Some people catheterize through the urethra and do not need a channel. Others use both.
Is the mucus a sign of infection?
No. Mucus is expected from the bowel patch. Cloudy urine with fever, pain, or a new bad smell may be an infection.
Will this protect my kidneys?
In most people, lowering bladder pressure helps protect the kidneys. This is checked with ultrasounds and blood tests.
Can I become pregnant after augmentation?
Many women have had healthy pregnancies after augmentation. Pregnancy needs close care from an experienced team, and if a cesarean section is needed, a urologist should be available to protect the bladder and channel.
How long will the channel last?
Many channels work for decades. Some narrow or leak and need a revision, which is usually a smaller operation.
Why do I need check-ups for life?
Bowel tissue in the urinary tract can lead to stones, changes in blood chemistry, vitamin B12 deficiency, and, rarely, cancer years later. Regular checks catch these early.
Sources this page draws on
- American Urological Association / SUFU, Adult Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guideline (2021)
- European Association of Urology, EAU Guidelines on Neuro-Urology
- Spina Bifida Association, Guidelines for the Care of People with Spina Bifida (2018)
- Urology Care Foundation, Neurogenic Bladder
- Campbell-Walsh-Wein Urology, Campbell-Walsh-Wein Urology, 12th edition (chapters on augmentation cystoplasty and continent urinary diversion) (2020)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.