Bladder neck constriction

Posted by tom1984 @tom1984, Jun 15, 2019

Had bipolar TURP in early April and latest cystoscope showed bladder neck contracture. Dr wants to do dilation but from what I have read this isn’t usually a permanent fix. Any other treatment suggestions or experiences? TURP followed acute urinary retention with several failed trials without catheter.

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Profile picture for tom1984 @tom1984

Thanks again for the reply. I opted for a bladder neck incision but the urologist did a urethral dilation as well while I was under general anesthesia. He said it is a waiting game now to see if I scar down again. Flow is already slowing down after only 4 weeks so I’m getting more pessimistic. Will mention the urethroplasty on my follow up visit.

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Hi. I have the same problem. I had turps and thought for the first time that I had amazing urine flow. Then it started to slow from 12 to 7. I'm scare of having any further procedures as the recurrence rate is high. I was wondering how your progress went given that you had the bnp a few years ago. All the best.

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Profile picture for androz @androz

Hi. I have the same problem. I had turps and thought for the first time that I had amazing urine flow. Then it started to slow from 12 to 7. I'm scare of having any further procedures as the recurrence rate is high. I was wondering how your progress went given that you had the bnp a few years ago. All the best.

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Sorry to hear you have the same issue but there is hope! I had a pretty severe bladder neck contracture after turp which almost completely closed down. My urologist did a bladder neck incision under general anesthesia (similar to how the turp operation went - same day surgery). He left the Foley catheter in for a week and the recovery was smooth with little to no bleeding. He said he made 3 incisions that looked like a Mercedes symbol. He didn’t inject any anti proliferative or steroid, just the incision. I had my 6 year follow up last month and I still have a strong stream so this one procedure seems to have fixed the bladder neck for me. He said the probability of it closing now is very low. He said if this happened today he might inject triamcinolone to up the probability of success but seems I didn’t need it. He also said if the contracture wasn’t too severe, he’s had success with the Optilume dilation that also injects an ant proliferative to help reduce scarring. My contracture wasn’t too severe for this however. In summary, there is hope that a follow up procedure of a bladder neck incision can provide lasting relief and you won’t be stuck in the recurrent treatment loop. I did worry a lot after the incision though. It was probably a couple years after that he was able to get me to not worry so much if my stream changed at all. Good luck and let us know how you make out or if you have any other questions.

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Profile picture for tom1984 @tom1984

Sorry to hear you have the same issue but there is hope! I had a pretty severe bladder neck contracture after turp which almost completely closed down. My urologist did a bladder neck incision under general anesthesia (similar to how the turp operation went - same day surgery). He left the Foley catheter in for a week and the recovery was smooth with little to no bleeding. He said he made 3 incisions that looked like a Mercedes symbol. He didn’t inject any anti proliferative or steroid, just the incision. I had my 6 year follow up last month and I still have a strong stream so this one procedure seems to have fixed the bladder neck for me. He said the probability of it closing now is very low. He said if this happened today he might inject triamcinolone to up the probability of success but seems I didn’t need it. He also said if the contracture wasn’t too severe, he’s had success with the Optilume dilation that also injects an ant proliferative to help reduce scarring. My contracture wasn’t too severe for this however. In summary, there is hope that a follow up procedure of a bladder neck incision can provide lasting relief and you won’t be stuck in the recurrent treatment loop. I did worry a lot after the incision though. It was probably a couple years after that he was able to get me to not worry so much if my stream changed at all. Good luck and let us know how you make out or if you have any other questions.

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Thanks for getting back to me so quickly Tom. Im having another cystoscopy next Tuesday to see exactly how bad it is. My Dr says it's rare and that I'm only the 3rd patient that he's dealt with. I'm also an x pat living in Cyprus. Medical treatment here is not too bad but certainly not as advanced as the US. The Dr explained that it was likely that he would do a bladder neck incision with a steroid injection. I will definitely pass on your experience to him next week, if that's ok. Thanks again for your help. It's a lonely and stressful world even with my family around me so your advice is a comfort. All the best.

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