Bladder neck contracture is a condition in which scar tissue forms at the junction where the bladder connects to the urethra, narrowing this passage and restricting the flow of urine. This condition often arises after surgical procedures involving the prostate or bladder and can significantly impact urinary function if left untreated.
Causes of Bladder Neck Contracture
The most common cause of bladder neck contracture is prior prostate surgery, particularly:
- Transurethral Resection of the Prostate (TURP)
- Radical Prostatectomy
- Laser prostate procedures
During these surgeries, tissue is removed or altered around the bladder neck, which can lead to inflammation and the eventual formation of fibrous scar tissue. Less commonly, bladder neck contracture may result from radiation therapy to the pelvic region, prolonged catheterization, or infection.
Symptoms
Because the bladder neck plays a key role in urine outflow, a contracture in this area can cause symptoms similar to those seen in urethral strictures or bladder outlet obstruction:
- Slowed or weak urine stream
- Difficulty initiating urination
- Frequent urination or urgency
- Feeling of incomplete bladder emptying
- Straining to urinate
- Intermittent flow or dribbling
- Recurrent urinary tract infections (UTIs)
- In severe cases, urinary retention
Diagnosis
Diagnosing bladder neck contracture involves a combination of patient history, physical exam, and diagnostic testing:
- Uroflowmetry: Measures the strength and rate of urine flow.
- Post-void residual test: Assesses how much urine remains in the bladder after urination.
- Cystoscopy: A flexible scope is used to directly visualize the bladder neck and confirm the presence and extent of the narrowing.
- Imaging studies: In some cases, retrograde urethrogram or voiding cystourethrogram may be used to evaluate the anatomy.
Treatment Options
Treatment is aimed at restoring normal urine flow and minimizing recurrence. Common approaches include:
- Bladder Neck Dilation: Gradual widening of the narrowed area using dilators. Often provides temporary relief but may require repetition.
- Transurethral Incision of the Bladder Neck (TUIBN): A minimally invasive procedure using a scope to make small incisions in the scar tissue to open the bladder neck.
- Laser Incision or Ablation: Lasers can be used to precisely cut or vaporize scar tissue.
- Urethroplasty or Reconstruction: In rare or complex cases, surgical reconstruction may be necessary if the contracture is recurrent or associated with other abnormalities.
- Clean Intermittent Catheterization (CIC): In select patients, especially those with recurrent narrowing, CIC may be used as a maintenance strategy to keep the bladder neck open.
Follow-Up Care
Bladder neck contractures can recur, even after successful treatment. Regular follow-up with a urologist is essential to monitor symptoms, assess urinary flow, and intervene early if needed. Early detection and management can preserve bladder function and improve quality of life.