Transurethral Incision/Resection of Bladder Neck

Overview

Transurethral = through or across the urethra (tube through which urine exits bladder)

Incision = making a cut in

Resection = cutting away or removal (some people refer to it as a “scraping”)

Bladder Neck = the opening of the bladder where the urethra begins

This procedure is done to open up a BNC or bladder neck contracture (restricting scar tissue)at the neck of the bladder. The bladder neck is the lower part of the bladder that connects to the urethra. The muscles may be cut at one or several locations. The operation is performed through the penis using a telescope and a hot wire loop to core out the central 2/3 of the prostate, rather like coring an apple. If the prostate is too large for this method, it may have to be removed through a cut on your tummy (this only applies to 1% of patients). If only the neck of the bladder is too tight it can be released with a cut.

Conditions for which the procedure may be recommended include obstruction of the bladder neck due to benign enlargement of the prostate gland (prostatic hyperplasia) or scarring (contracture) that can occur after resection of the prostate. It can also be performed to treat a condition in which there is dysfunction of the bladder neck leading to obstruction (dyssynergia).

 

The most common reasons to have a bladder neck contracture are:

  • a history of transurethral resection of the prostate, referred to as a TURP (prostate scraping procedure) or transurethral resection of a bladder tumor
  • a history of an open prostate operation such as radical prostatectomy (removal of the prostate for cancer treatment) or simple prostatectomy (removal of the center portion of a prostate that was too large for a TURP procedure)
  • a history of radiation and/or radioactive seed implantation for prostate cancer treatment

 

The symptoms characteristic of a bladder neck contracture are those of obstructive urination pattern. The most common symptoms are:

  • Straining (need to push to begin urination)
  • Hesitancy (delayed onset of urination following the urge to urinate)
  • Slow or diminished force of stream
  • Intermittence (urine stream that starts and stops)
  • Sensation of incomplete emptying

Other symptoms that may be associated are what we call irritative symptoms and include: frequency of urination, urgency to urinate and nocturia (getting up at night to urinate).