Bladder Neck Contracture

Radical prostatectomy is a surgery that involves making a connection (anastomosis) of the bladder neck to the membranous urethra after the prostate is removed. If that connection becomes narrow from scarring, this is called a bladder neck contracture. Bladder neck contractures can also occur after radiation. Bladder neck obstruction after prostate surgery or radiation is suggested by a slow urinary stream. However, patients can develop other symptoms such as male urinary incontinence. Although incontinence in men after prostate cancer treatment is often due to a lack of sphincter function and control, when there is bladder neck obstruction, the leakage can be from what is called overflow incontinence. The blockage associated with bladder neck contractures can lead to bladder and possibly kidney damage.

Treatments

Bladder neck contractures are generally initially managed with urethral dilation or an incision of the bladder neck, a type of internal urethotomy procedure called transurethral incision of a bladder neck contracture (TUIBN). This incision can be performed with a small knife that fits through the scope, or with a laser. In cases of recurrent contractures after radical prostatectomy, treatment options include open surgery to excise the narrow area and reconnect the urethra. This is possible but is a major undertaking and is not without risks.

Risks & Complications

After radical prostatectomy, a rare complication is a total obliteration of the bladder neck. A urethral catheter is always placed at the time of surgery, and when removed, patients develop severe obstruction. Often, a tube is placed directly in the bladder called a suprapubic tube.

After radiation (external beam and/or radioactive seed placement), damage and blockage can involve the bladder neck alone or also involve the prostatic urethral and/or external sphincter. We have seen patients who have developed damage extending from the bladder to the bulbar urethra with a total obliteration of the bladder neck.

The treatment of these complications is individualized. Options include a permanent suprapubic tube, a formal urinary diversion (bringing the bladder to the skin of the abdomen using a segment of bowel), and major open surgery in an attempt to repair the damage, which may then lead to incontinence that requires treatment.

For additional questions or concerns, please contact us at (864)295-2131.