What is a bladder neck contracture? 

• Narrowing or scarring of the bladder neck, which is the muscular area at the base of the bladder that connects to the urethra.

• This narrowing can obstruct the flow of urine from the bladder to the urethra and out of the body, leading to various urinary problems.

What causes bladder neck contracture? 

• Prior surgery:

  • TURP - resection of the prostate for benign enlargement (BPH).

  • Prostatectomy - removal of the prostate for cancer.

• Radiation:

  • Pelvic radiation for colorectal cancer or prostate cancer.

  • Brachytherapy for prostate cancer.

What are the signs and symptoms of bladder neck contracture? 

• The signs and symptoms of BNC may include: 

  • Difficulty passing urine or slowed urine flow. 

  • Frequent urination. 

  • Pain or discomfort during urination. 

  • Recurrent urinary tract infections. 

  • Blood in the urine.

  • Inability to empty the bladder completely. 

  • Urinary incontinence or leakage. 

How is bladder neck contracture diagnosed? 

• Uroflow:

  • This is a diagnostic test used to measure the volume and speed of urine flow during urination.

  • It is non-invasive and painless. It is done in clinic.

  • During uroflow, the patient urinates into a special device that measures the amount of urine voided, the time it takes to void the urine, and the speed of the urine flow. The test can also detect any interruptions in the flow of urine, which may indicate a blockage or narrowing of the urethra.

• Post-void residual (PVR):

  • Often done after uroflow, this is a simple ultrasound of the bladder to measure how well you have emptied. 

• Cystoscopy:

  • This is a diagnostic procedure used to examine the inside of the bladder and urethra.

  • During the procedure, the patient lies supine on an examination table. The doctor then inserts a thin, flexible tube called a cystoscope through the urethra and into the bladder. The cystoscope has a light and a camera attached to it, which allows the doctor to see inside the bladder and urethra on a video screen. 

What are treatment options for bladder neck contracture? 

• There are several treatment options available for bladder neck contracture, depending on the severity of the condition.

• Optilume urethral dilation:

  • Optilume is the brand name for a type of balloon used for dilation.

  • It is a minimally invasive procedure that uses a special balloon catheter to dilate the scarred bladder neck. The balloon is coated with a medication called paclitaxel which discourages scar tissue formation.

  • Optilume urethral dilation is performed on an outpatient basis, typically under local anesthesia or moderate sedation. It does have to happen in the operating room for insurance reasons.

  • You will have a catheter for 2 days after this procedure. 

  • Dilation is best for very short and very flimsy scar tissue.

• Robotic surgery:

  • The surgical robot is used to approach the bladder neck from inside the abdomen. It may also access the bladder neck directly through the bladder.

  • Depending on the etiology and the extent of contracture, various methods can be used to open the bladder neck. These include removing the scar tissue and advancing healthy bladder mucosa forwards or using a mucosal graft taken from inside the mouth to patch the bladder neck.

  • You will have a catheter for 2 weeks after this procedure.

  • There is a significant risk of incontinence or increased urinary leakage after this surgery due to potential damage to the urinary sphincter. Sometimes this leakage is severe enough as to need additional surgeries in the future.