Causes of Bladder Neck Contracture
A narrowing of the bladder neck is a common pathology in urology and can have several causes:
- Cramping of the muscles around the bladder neck
- Benign enlargement of the prostate, whereby the prostate tissue presses on the neck of the bladder and narrows the urethra at this point
- Scarring due to chronic inflammation of the prostate
- Scarring as a result of surgical procedures on the prostate for the treatment of benign prostate syndrome (BPS) or prostate cancer
- Less common: congenital malformation of the bladder neck or mechanical injury
Surgery on the prostate can lead to increased scarring at the junction of the bladder and prostate. Bladder neck stenosis usually occurs in patients after a radical prostatectomy, in which the prostate is completely removed to treat prostate cancer. Transurethral prostate operations - i.e. operations in which the instruments are passed through the urethra to remove the inner prostate tissue - can also result in a narrowing of the bladder neck. If patients experience the above-mentioned symptoms after prostate surgery, detailed urological examinations and, if necessary, an operation to treat the narrowing of the bladder neck are necessary.
Bladder Neck Incision: Surgery, Recovery Time & Long Term Effects
The short procedure can be performed under general anesthesia or spinal anesthesia. During this prostate operation, the constriction is incised using an optical instrument inserted via the urethra and an electric hook(bladder neck incision) or the entire scarred tissue is removed with an electric snare as a bladder neck reconstruction. Bleeding from opened vessels is stopped with an electric current. After the procedure, a permanent catheter is inserted and left in place for three to five days. Once the catheter has been removed, the bladder can be emptied again undisturbed and with a good urinary stream.
BNI Urology: Performing Bladder Neck Reconstruction with the Da Vinci Method
Bladder neck reconstruction is usually performed as open urethral surgery. The modern, minimally invasive Da Vinci method can also be used here. In so-called "laparoscopic robot-assisted surgery", the procedure is performed via laparoscopy with the support of the Da Vinci surgical robot. The surgical instruments are inserted through a few small incisions in the skin at the level of the navel. The Da Vinci surgical robot transfers the surgeon's movements to the instruments with extreme precision. A high-resolution camera also provides the surgeon with a detailed 3D view of the surgical field. This allows them to make much smaller and more precise incisions. The advantages of this method include less blood loss, the best possible protection of the patient's nerves and tissue, and a shorter healing process thanks to the gentle access to the urethra, bladder and prostate.
The criteria for choosing a surgical method are the patient's individual circumstances, as well as the causes and progression of the bladder neck stenosis. The attending physician will clarify all treatment options, their prospects of success and possible risks in a comprehensive consultation with the patient before deciding on a procedure. Do you suspect an existing bladder neck constriction? The urology specialists at KontinenzZentrum Hirslanden in Zurich will be happy to provide you with information about your individual assessment and treatment options.
