Occasionally, nothing works well to control the bladder and wetness is a constant and unacceptable companion. It may then be necessary for a urologist to place an opening to the bladder in the front of the body, a procedure called a continence viscostomy. In women this allows for much better visualization of an entrance to the bladder and with an appropriate valve implantation self-catheterization may be accomplished through the opening.
If the bladder is very small and shrunken, a bladder augmentation procedure sometimes may be performed by surgically taking a piece of colon and using it to enlarge the bladder. This allows for more storage room.
An indwelling Foley catheter may irritate the bladder wall, and bladder stones may form in response to this irritation. Bladder stones may increase the likelihood of infection and decrease urinary flow. The stones usually are removed by a fairly simple surgical procedure called a cystoscopy, which is performed through a "scope" that the urologist uses to look into the bladder.
With chronic, significant infections, the bladder wall may become so damaged that the infection cannot be cleared and the bladder must be bypassed or diverted. A piece of intestine is used to divert the urine to a bag on the body like a colostomy. This procedure is reserved for extreme situations, but it does permit infection to be controlled more easily.
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