Is it difficult to urinate after prostate surgery? It could be due to bladder neck contracture!

Have you recently undergone surgery or cancer treatment for your prostate gland? Everything went well, and after a while you came home, did you start to notice some changes in your urination ? Maybe the flow of urine has slowed down a bit, or you feel like you have to strain a little to urinate ? If this has happened to you, it could be due to a condition called Bladder Neck Contracture, which we are talking about today. Don't worry, we will talk about this in simple terms.

Simply put, what is Bladder Neck Contracture?

Okay, to understand this, let's first take a look at how the urinary system in our body works. Think of your bladder as a balloon filled with water. This is the bag that collects and stores your urine . At the bottom of this bladder, like the mouth of the balloon, there is a place where it connects to a small tube. We call this the bladder neck. When you urinate , the urine comes out through this neck and enters the urethra.

Now, after things like prostate surgery or radiation therapy, scar tissue can form at the bladder neck. Just like a scar forms when we have a wound on our skin. This scar tissue causes the bladder neck to gradually narrow or contract. That's what we call Bladder Neck Contracture .

What kind of treatments can cause this condition?

This is often a side effect of prostate treatments. This risk is especially high after the following treatments:

• Prostatectomy: Surgical removal of the prostate gland.
• Radical Prostatectomy: Complete removal of the prostate gland due to cancer.
• Transurethral resection of the prostate (TURP): A surgery in which a device is inserted through the urethra to remove parts of the prostate gland.
• Radiation therapy: Providing radiation treatment.

This is not a very common condition. It is estimated that approximately one in ten men who undergo prostate surgery will develop this condition. But it is important for you to be aware of this.

What are the symptoms of this condition?

These symptoms often start to appear within three to six months of prostate surgery. They may not be noticeable at first, but they can gradually increase over time. See if you have any of these symptoms.

Why is this happening? What is the reason?

Although doctors cannot give a 100% definitive reason for this, there are two main reasons that are thought to be the cause.

1. Postoperative complication: After removing the prostate gland, the doctor will reconnect your bladder neck to your urethra (this is called an anastomosis). Sometimes, a small blood clot (hematoma) can form between the stitches at the site of this connection. When this happens, the stitches can pull, leaving small gaps in the connection. As the body heals, these gaps are filled with the scar tissue we mentioned earlier. This scar tissue is what blocks the passage.

2. Insufficient blood supply: Sometimes, if the stitches used during surgery are too tight, the blood supply to the area can decrease. When the blood supply is reduced, the tissue does not heal properly, and instead, scarring is more likely to occur.

The risk of developing bladder neck contracture after prostate surgery may be slightly increased, especially for people with other medical conditions that affect blood circulation in the body, such as diabetes or heart disease.

How does a doctor diagnose this exactly?

If you have the symptoms mentioned above, the first thing you should do is see your doctor again. Or, it would be best to see a urologist. He or she will examine you and run some tests to confirm the condition.

What are the treatments for this?

This is a treatable condition. Depending on the severity of your condition, your doctor will choose the most appropriate treatment for you.

• Dilation: This is not surgery. It is something that can be done in the doctor's office. Thin, gradually increasing tubes are inserted through the urethra, gradually widening the area of ​​obstruction.
• Transurethral procedure: This is a minor surgery performed under anesthesia. Similar to a cystoscopy, a camera-equipped instrument is inserted and an electric current is used to cut and remove the scar tissue that is causing the blockage.
• Urinary reconstruction and diversion (major surgery): This is done very rarely, and only in very serious cases. In this procedure, part or all of the bladder is removed and another way for urine to exit the body (such as a small opening in the abdomen) is created.

Isn't this situation just getting better?

No. Bladder Neck Contracture will not go away on its own . However, if your condition is very mild, meaning you can empty your bladder completely and there is no damage to your kidneys, your doctor may recommend a "wait and see" approach. This means waiting for a while without treatment to see if your symptoms improve.

When should I see a doctor? At what time should I go to the Emergency Department (ETU)?

This is a very important part. You need to know exactly what this is.

When to see your doctor:

• After prostate treatment, if you develop any of the symptoms we discussed earlier.
• If you have already been treated for Bladder Neck Contracture, but the symptoms recur or worsen .

When to go to the Emergency Treatment Unit (ETU) immediately:

If you experience any of the following, go to the nearest hospital Emergency Department (ETU) immediately without thinking anything else.

• If you can't urinate at all.
• If you experience severe pain in your stomach or groin area .
• If you sweat excessively .

These are emergencies, so don't delay at all.

Can this come back after treatment?

For most people, the condition resolves completely after treatment. However, sometimes scar tissue can form again and the blockage can reoccur. The risk of recurrence is particularly high in the following situations:

• If you have undergone radiation therapy.
• If you have had other surgeries involving your urethra.
• If there was a complication during the first treatment.

If it happens again, you may need to undergo treatment again. That's why it's important to always be aware of the symptoms.