Bladder Neck Contracture: Causes, Symptoms, Treatment, Diagnosis
What is Bladder Neck Contracture?
Bladder Neck Contracture is a rare pathological condition of the genitourinary system which occurs in males after they have undergone a prostate surgery. There are various surgical procedures performed for conditions of the prostate like benign prostatic hyperplasia in which the prostate gets enlarged. To treat this condition, surgeons treat this condition by removing a part of the prostate gland.
Bladder Neck Contracture is something that is usually formed post-procedure at the junction of the bladder outlet and the prostate gland. The prostate gland is located between the bladder and the urethra. In cases where an individual is suffering from prostate cancer then the prostate needs to be removed completely. In such cases, the bladder neck is directly connected to the urethra.
Sometimes, there is scar tissue formation at the junction of the bladder neck and the urethra resulting in the narrowing of the pathway and cause Bladder Neck Contracture. The symptoms of Bladder Neck Contracture usually start to appear within 5-6 months after a prostate surgery. There will be a gradual decline in the urinary output. This may sound normal first but over time the individual may not be able to urinate.
In some cases, an individual may experience urinary incontinence when the bladder becomes too full. Some of the other symptoms of Bladder Neck Contracture are straining to urinate, urine stream being very slow, no urine output in some cases and a sensation of incomplete emptying of the bladder due to Bladder Neck Contracture. It quite rare but sometimes kidney or bladder damage has been reported to be caused by Bladder Neck Contracture.
What Causes Bladder Neck Contracture?
The exact cause of Bladder Neck Contracture is not yet known but some studies suggest that the gaps that are left behind after a prostate surgery or after creation of anastomosis when the bladder neck is connected to the urethra directly is the cause for development of Bladder Neck Contracture.
In cases of prostate cancer, when the prostate is completely removed there may be hematoma formation beneath the sutures causing the sutures to stretch or break which may result in formation of gaps which are then filled by scar tissue resulting in Bladder Neck Contracture.
Another possible cause for Bladder Neck Contracture is poor blood supply to the anastomosis that is formed after removal of prostate. Some of the sutures are too tight and tend to cut off the blood vessels near the anastomosis resulting in poor blood supply to the anastomosis causing Bladder Neck Contracture. If an individual who has a history of diabetes and heart disease undergoes a prostate surgery then the chances are more of him developing Bladder Neck Contracture.
What are the Symptoms of Bladder Neck Contracture?
As stated above, some of the symptoms of Bladder Neck Contracture are slow urinary stream, gradual decline in urinary output with ultimately no urine output if there is complete obstruction, sensation of not completely emptying the bladder, and in some cases urinary incontinence.
How is Bladder Neck Contracture Diagnosed?
There are several tests available to confirm the diagnosis of Bladder Neck Contracture. To begin with the physician will take a history of the patient inquiring as to whether there is a history of prior prostate problems and/or surgery. If the history of the patient points towards Bladder Neck Contracture then the physician may perform a cystoscopy in which a thin tube is inserted through the urethra into the bladder to look at the internal structures.
The bladder is filled with sterile water so as to expand the bladder for a better view. This test will clearly show scar tissue formation within the bladder neck and confirm the diagnosis of Bladder Neck Contracture. Additionally, a cystourethrogram may be performed which utilizes x-ray.
In this study, a catheter is inserted through the urethra into the bladder. A contrast material is introduced into the bladder and x-ray studies are taken. This study will also show the presence of scar tissue formation near the bladder neck confirming the diagnosis of Bladder Neck Contracture.
How is Bladder Neck Contracture Treated?
There are various treatment options available for treatment of Bladder Neck Contracture. Dilation is one of the preferred approaches to treat Bladder Neck Contracture. It is a nonsurgical procedure in which tubes of increasing diameter are inserted through the urethra to widen up the opening to allow a catheter to be inserted to drain urine from the bladder.
A surgical procedure called transurethral incision is also one of the preferred treatments for Bladder Neck Contracture. In this procedure a resectoscope is introduced into the bladder from the urethra to visualize the bladder neck. Then a few incisions are made in the bladder neck to allow the scar to relax and open up thus treating Bladder Neck Contracture.