Are you also having difficulty urinating after prostate surgery? Could it be due to bladder neck contracture?

Do you remember having difficulty urinating after prostate surgery or cancer treatment? Perhaps you felt like your urethra was narrowing, or you felt like there was still urine left in your bladder after you finished urinating ? If you have experienced any of these things, you may have developed a condition called bladder neck contracture, which doctors call bladder neck contracture . This may sound a bit new to you, but don't worry. Let's talk about it simply, in Sinhala that you can understand.

What is bladder neck contracture?

Simply put, your urinary bladder is a small sac-like organ in your lower abdomen that collects urine (pee). It's like a balloon, expanding when it's full of urine , and contracting again when you urinate . At the bottom of this bladder, where it connects to the urethra , is what we call the bladder neck . This is like a gate, where urine starts to flow out.

Now, sometimes after prostate treatment, especially after surgery, scar tissue can form at the urethral opening. That scar tissue causes the urethra to become narrow, or contract. It's like something getting stuck in a water pipe and reducing the flow of water. When the urethral opening narrows, it can make it difficult to urinate , and it can also lead to other conditions that affect the bladder and kidneys.

Just think, just like when a road is blocked, it's difficult for vehicles to pass through, but when the bladder is blocked, it's difficult for urine to pass out.

What types of prostate treatments can cause this condition?

This does not happen with all prostate treatments. However, there may be a risk of bladder neck contracture after these treatments:

• Prostatectomy : This involves removing all or part of the prostate gland.
• Radical prostatectomy : This is also a surgery that completely removes the prostate gland, especially in cases of cancer.
• Transurethral resection of the prostate (TURP ) : In this procedure, an instrument is inserted through the urethra to cut out and remove the enlarged parts of the prostate gland.
• Radiation therapy : High-energy radiation therapy that destroys cancer cells .

Not everyone will experience this condition after these treatments, so keep that in mind.

Can this bladder neck contracture be cured?

Yes, it can definitely be cured. If you have these symptoms after prostate treatment, see a doctor immediately. He or she will decide what treatment is right for you. There is no reason to be afraid.

How common is this condition?

This is actually a very rare condition . According to experts, only one in ten people after prostate surgery develops this condition (Bladder Neck Contracture). So don't worry unnecessarily.

What are the symptoms of bladder neck contracture?

These symptoms don't come on suddenly, they develop gradually. You may not even notice them at first.

• Having to push hard when you start urinating . It doesn't just come out , you have to strain a little.
• Pain when urinating (dysuria). It may feel like a burning sensation or a stinging sensation.
• Weak pee stream. You don't urinate as often as you used to.
• A pee stream that starts and stops. The urine does not flow continuously, but rather in intermittent bursts.
• The feeling that the bladder has not been completely emptied even after urinating (urinary retention). It feels like there is still urine left.
• Frequent urinary tract infections ( UTIs ). Urine remains in the bladder, making it easy for germs to grow.
• The formation of bladder stones.
• The involuntary leakage of urine , or the inability to control urination (overflow incontinence).

These symptoms often begin to appear within three to six months after prostate surgery. At first, you may not notice much of a urinary tract infection. But gradually this can increase, and you may even be unable to urinate at all. Therefore, if you have any of these symptoms, it is best to seek medical advice as soon as possible.

Why does this bladder neck get blocked? What are the causes?

Doctors and researchers still can't say exactly why this (Bladder Neck Contracture) occurs. However, they think there are a few main reasons.

One is a complication that occurs after surgery to remove the prostate gland . Your bladder neck is connected to the prostate gland. During the surgery, the urologist reconnects your bladder neck to the urethra. This is called an anastomosis . Now, as you heal, a blood clot (hematoma) can form under or between the sutures. This blood clot can cause the sutures to pull or even break. Then, gaps form where the connection was made. These gaps are filled with scar tissue. That scar tissue is what blocks the passage between the bladder and the urethra.

Another reason could be that the anastomosis is not getting enough blood supply . If the stitches are too tight, the nearby blood vessels can become constricted and blood flow can decrease. This can also lead to scarring.

Who is affected by bladder neck contracture?

This condition can occur in anyone who has had prostate surgery.

However, if you have other medical conditions that affect blood flow when you have prostate surgery – for example , diabetes or heart disease – you may be at slightly increased risk of developing this bladder neck problem.

How is this condition diagnosed?

If you have symptoms of bladder neck obstruction, a urologist will be the only one who can confirm this. He or she will examine you and order a number of tests.

What tests are being done for this?

The doctor may do tests like these:

• Cystoscopy : In this procedure, the doctor inserts a small tube (cystoscope) with a camera and light attached through your urethra into your bladder. Don't worry, you will be given local anesthesia so that you won't feel any pain. The bladder may also be filled with sterile water or saline solution to see inside the bladder clearly.
• Cystourethrogram : In this test, the doctor inserts a small, flexible plastic tube (urinary catheter) through your urethra into your bladder. A special dye (contrast dye) is injected through the tube into your bladder. X-ray images of your bladder are then taken. The dye causes the bladder to swell and show the inside clearly.
• Voiding cystourethrogram (VCUG): This is similar to the cystourethrogram above, but an X-ray is taken while you are urinating (voiding).
• Uroflow test : This tests how well your bladder empties when you urinate . It measures things like the speed and amount of urine you pass.
• Post-void residual urine test (PVR test ) : This uses an ultrasound scan to measure how much urine is left in the bladder after you have finished urinating .

These tests allow the doctor to understand exactly how blocked your bladder is and what the cause is.

How is bladder neck contracture treated?

There are several treatment options for this. Your doctor will choose the best treatment based on your condition.

• Dilation : This is not surgery. It is something that can be done in the doctor's office. He or she will insert gradually larger tubes into your urethra. This will gradually dilate the area that is blocked. Then, a small tube (urinary catheter) will be inserted to drain urine from your bladder.
• Transurethral procedure : This is a surgery performed under anesthesia. The doctor uses a resectoscope, a device similar to a cystoscope, and uses an electric current to remove scar tissue that is stuck in the urethra.
• Urinary reconstruction and diversion : This is only done in cases of severe bladder neck obstruction. Sometimes all or part of the bladder needs to be removed. Then a new way for urine to exit the body is created. Usually, a small opening (stoma) is made in the abdomen through which urine is collected into a bag.

Your doctor will tell you more about these treatments.

Does Bladder Neck Contracture heal on its own?

No, this condition will not go away on its own. However, if your contracture is not too severe, that is, it is mild , your doctor may take a “wait and see” approach. This means that both you and the doctor will watch to see if there is a change in your symptoms.

Your blockage is only considered mild if it's not causing any damage to your kidneys and you can completely empty your bladder without any problems.

How long does it take to recover after bladder neck surgery?

Most people recover from bladder neck surgery in about two to three weeks . However, recovery time varies from person to person. Your doctor will give you a specific idea of ​​this.

Can bladder neck contracture be prevented?

There's really nothing you can do to prevent this, as it's a very rare form of scar tissue that can occur after prostate treatment.

What should I expect if I have bladder neck contracture?

Treatment for this condition is generally successful. However, sometimes scar tissue can recur and contracture can occur . Scar tissue is particularly likely to recur in the following situations:

• If you have received radiation therapy .
• If you have had other surgeries or procedures on your urethra.
• If any problems occurred during the initial bladder neck treatment.

If the blockage recurs, you may need further treatment.

When should I see a doctor?

If you have any symptoms of bladder tightness after prostate treatment, be sure to see a doctor . Also, if you are being treated for this, tell your doctor if you develop new symptoms or if your existing symptoms worsen.

When should I go to an Emergency Treatment Unit (ETU) ?

If any of these things happen, go to an emergency room immediately :

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

What questions should I ask my doctor?

It may be helpful to ask these questions when you see your doctor:

• How did I get this bladder neck contracture?
• What treatment option do you recommend for me?
• How long does it take to recover after that treatment?
• Can my bladder tightness come back after treatment?

Remember, bladder neck obstruction is a rare condition that makes it difficult to urinate . For most people, symptoms go away after treatment. However, it is possible that the condition will recur and require further treatment.

Take-Home Message

If you have symptoms such as difficulty urinating , a weak urethra , or incomplete emptying of urine after prostate treatment, it may be due to a condition called Bladder Neck Contracture . Although this is a rare condition, it can be treated . Don't panic, see a urologist as soon as possible. He or she will help you decide on the best treatment for you and help you find relief. Don't hold anything back, talk openly with your doctor. Good health to you!