Question Title: Bladder Incontinence

Dear Doctor

Forgive me if this message appears twice but I tried earlier to post it and it did not appear on the forum. My 66 year old mother has suffered total bladder incontinence for some years and it really gets her down. Medications do not seem to do anything to control the problem. She was offered a procedure which involved taking a piece of her intestine and somehow grafting it on to her bladder but as it involved her being knocked out for some hours her cardiologist did not agree to this as she has unstable angina. Last week however she was told that another procedure may be possible and it would involve only a "few snips" and half an hour under general anaesthesia. Do you know what this procedure would involve? My mum is anxious to know but it would depend upon her cardiologist agreeing whatever the procedure might involve.
Thanks in advance for your reply.

Dear Ann,
There are different ways of dealing with urinary incontinence. From what you have described your urologist wants to perform an ileovesicostomy. A small piece of bowel is attached to the bladder and brought out to the skin where the urine is collected into a bag. This is a major surgical procedure, and with your mother’s cardiac risks, could involve setbacks and morbidity.
From what you have described I suspect the alternative procedure that your doctor has recommended is autoaugmentation. This is a simpler, less risky procedure. It primarily involves making an incision through the muscle layer of the bladder, while keeping the inner layer( called “mucosa”) intact. The mucosa then will bulge out , and presumably allow for an expansion of the bladder volume, thus decreasing the degree of incontinence. Good results have been reported with this procedure, without any major complications.
You should also discuss the option of clean intermittent catheterization( CIC) with you doctor, before considering other alternatives. This( CIC) in combination with medications may help reduce her problems with incontinence. This means that the patient, if he/she is manually capable, or a family member or caregiver if the patient is unable to, would catheterize himself/herself about 4 times per day. to keep the bladder empty.
Unfortunately, these have been only educated guesses as to what procedures your urologist was indeed discussing.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568).

Sincerely;
HFHS-M.D. BE
* Keyword:incontinence/ cystoplasty