Bladder Neck incision

Overview

Bladder neck incision helps to remove any blockage at the mouth of the bladder for smooth flow of urine through the urethra. If the problem is left untreated or delayed, then a weakened bladder may lead to many complications like urinary tract infections, kidney damage, lack of bladder control and bladder diverticula.

The major cause of bladder neck obstruction is an enlarged prostate that becomes swollen, squeezes the urethra and prevents smooth flow of urine. The condition is likely to occur in men over age 50, but it can also occur in women. Although, the condition is rare in women, it generally occurs when the bladder drops into the vagina due to a weakened vaginal wall.

Another major cause of bladder neck obstruction is linked to genetic flaw in the bladder structure, its connective tissues and the surrounding muscles. Refer to a doctor if you identify any of these symptoms:

• Increased urinary discharge
• An irregular urine output
• Increased urinary urgency
• Feeling of bladder fullness
• An inability to control the need to urinate
• Pelvic pain (common more in men than women)

It should, however, be known that the symptoms of bladder neck obstruction are quite similar to neurogenic bladder and urinary tract infections. Only specific tests and diagnosis can confirm that a person is suffering from bladder neck obstruction. These tests include:

• Video Urodynamics- The procedure uses ultrasound and X-rays to take detailed images of your bladder and evaluate the bladder function. A catheter is inserted into the bladder to empty urine out of it. Fluid is filled inside the bladder with the tube. You are asked to cough and urinate as much as possible. It is during this time when images of the bladder are captured.
• Cystoscopy- Cystoscopy uses a long tube, called cystoscope through the urethra into the bladder to look inside. During the procedure, liquid is filled inside to get a better viewing.

Treatment options of bladder neck obstruction include medications and bladder neck incision. Medications help to relieve pain and discomfort while urinating, but it is a primary step to the condition. For a more severe condition, surgery is required. Before you are transferred to the operation table, there are a few preparations to be taken.

Before the Treatment

This is how you prepare before bladder neck incision procedure:

• You will have to undergo through a series of blood tests, ECG (electrocardiogram) and chest X-rays.
• If a patient is on anticoagulant therapy, it should be stopped immediately since the therapy may interrupt with the operation. Refer to a cardiologist to replace anticoagulants with injections in the abdomen.
• Talk to your anaesthesiologist and tell him/her about the types of medications you are on and whether the anaesthetics given to you will have any side effects during and post surgery.
• Just before the surgery, you may be given some tablets for nausea, tension and pain prevention.

How it is Performed

• After you are administered anaesthesia, you are placed in a gynaecological examination position.
• An incision is done in the bladder neck and a resectoscope is inserted through the urethra that has a camera and light attached to it. This allows better viewing of the bladder neck. A cutting instrument, which is attached to the resectoscope, allows making a small incision inside the wall of the bladder neck.
• It should be noted that the surgery does not explain the reason of the obstruction, but it definitely relieves pressure from the blockage and give you ease from the symptoms.

Recovery

After the operation, the patient is transferred to the recovery room. A catheter attached to the bladder causes spasms and intense pain, but this lasts for a few seconds. However, you may feel a burning and strong sensation in the urethra for some days after the surgery. It is normal to see blood in the urine, but you are kept under constant observation for urine irrigation. Needless to worry, the symptoms are treated with the right pharmaceutical agents to give you relief.

Generally, the catheter is removed after one day and the doctor checks if you are able to pass urine smoothly. Before you are discharged, the doctor prescribes certain antibiotics, instructs you about the importance of drinking plenty of fluids and restricts you from physical exercises. Make sure you have lots of water and liquids to help flush any blood clot from the bladder. A proper care ensures quick recovery of bladder neck incision and lets you return to the normal routine of life.