Bladder ureteral obstruction/stricture

Colleen, thanks for asking. The Uro said that I'm not a good candidate for AUS because my BNC surgery (had a TUR in Sept 2020) suggests that scar tissue will continue to need self-catheterizing, which could tear the device, requiring emergency surgery. I told him I hadn't catheterized in weeks, but he thinks scar tissue will likely obstruct bladder neck down the road, in absence of catheterization. He favors the indwelling catheter solution and has several patients that are happy and active wearing them. I've had to endure them three times in the last four years and don't care for them at all; plus, I came across this quote from Dr. Viers: "...chronic indwelling catheter drainage... is associated with extremely poor quality of life." Plus I believe there are other long-term downsides. The last option is the Supra-Pubic Catheter. What worries me here is the potential for squamous cell bladder cancer. About 10 years ago, I had squamous cell skin cancer removed from my ear. No problem, but does this mean I am prone to this? Can this be nipped in the bud by aggressive bladder cancer screening? // As of now I've made my peace with condom catheters, though not infrequently the adhesive will cause unpleasant chafing that requires me to take a break from them for a couple days, and wear pull-ups, which rather aggravate the situation. It's a Catch-22. I'm waiting for a product to arrive, a "barrier foam", made by the same company that makes the condoms, that may help prevent this. I certainly hope so, because the condom caths seem to me to be the most benign solution. I really appreciate your checking back with me; and sorry for the long answer. I need to get a second opinion from one of the Mayo uros.

I am a 41 yr old Male.

I am supposed to have surgery this week for a tight bladder neck. I have had the issue for 7 years and my bladder is getting weaker.
I am very scared and not sure if it is the right decision. I have been on flowmax and it helps some. I am on two pills totaling .80.
I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. The meds cause some side effects like eczema and some dizzyness, maybe even some back and side pain.

If anyone has an experience with having a BNI at 5 and 7 could you please share with me your experience>?
My BIGGEST fear is incontinence. I am 41 have two kids and a beautiful wife.

Did you get and form of Incontinence?
Did you get the dreaded Retro?
How long was your recovery time?
Would you share with me your outcome and if any complications?
Did you get the results you were looking for?
Would you do it again knowing what you know now?

Am I jumping the gun having this surgery or am I scared of things that are very unlikely?

I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share.

Thank you,
Joel P

Hi @joelp and welcome to Mayo Clinic Connect. You'll notice that I moved your message to this existing discussion where @jimb1950 @jakedduck1 @tom1984 @predictable @alderton @victor1930 @jackpine @seamayofan are talking about similar issues with bladder and urether obstruction issues.

Your asking great questions about your upcoming surgery for a tight bladder neck that I think some members will be able to provide tips and have experiences to share.

You mention that incontinence is your biggest fear and that you'd like to know more from those who had bladder neck incision (BNI) about their recovery and if after initial good flow post surgery can regress back to slow flow.

Joel, do the doctors know what the underlying cause of your obstruction is?

I have been told the reason is a tight and high bladder neck.

Hi @joelp. Hope I can be helpful, but I want to be sure what we are talking about. I understand that the bladder neck is located near the prostate gland and is the point of exit for urine leaving the bladder and the body through the "urethra" (in contrast to the "ureter," which is one of the two tubes that carry urine from the kidneys into the bladder).

I had surgery in the same area, but not a Bladder Neck Incision (BNI). Mine was a combination of a TURP and a TURB -- transurethral resection of the prostate (and the bladder lining). A large piece of the prostate was removed along with several small tumors on the surface of the bladder lining. Within a few weeks, my bladder performance was 20 years younger, and it has remained close to normal. Leading up to that surgery, I too had been on Flomax for several years, but my prostate grew beyond the limits of the drug's ability to be helpful, so we agreed to go ahead with the surgery.

After surgery, I have had regular visual inspections of the inside of my bladder with a cystoscope. In that connection, my urologist also measures my urine flow and samples it for signs of tumor cells. So far, so good, 12 years after my original surgery. Martin

I had same problem started post prostate surgery removal. Eventually it was completely scarred over had the Supra pubic cath & finally had corrective surgery at Mayo Rochester. Dr Viers was best thing that happened to me in past year.

Joel, sorry I didn't see this in time. Have had terrible incontinence since the BNC surgery. Am still trying to solve the problem and have made an appointment in Apr. with Dr. Viers. As of now I am using an indwelling catheter. For several months, I tried to make condom catheters work, but finally threw in the towel as there were too many problems - leaks, skin issues etc. Good luck, please let us know how it went.

That could be my problem,ever since I had a camera inserted into my penis by a urologist some 15 yrs ago I have had some difficulties urinating.Latley I am experiencing pain at the start of urinating the pain is in the shaft or my penis.I only have to get up once at night.

@tessa2004, if the pain at the start of urinating is a new symptom, you may wish to consult your doctor. It could be a urinary tract infection or other problem that needs medical attention. Is it a new symptom? Have you talked to your doctor about it?

Did you have the AUS put in? I'm looking at going that route.