Rigi10™ Malleable Penile Prosthesis
Also Known As
Bladder neck stenosis, Vesicourethral stenosis, BNC, Post-prostatectomy bladder neck contracture, Anastomotic stenosis (urethra)
Definition
Bladder neck contracture (BNC), also known as vesicourethral stenosis, is a medical condition characterized by the formation of scar tissue at the bladder neck, which is the junction between the bladder and the urethra.¹ This scarring process leads to a narrowing or stricture of the bladder outlet, impeding the normal flow of urine from the bladder.² The condition typically develops as a complication following surgical procedures involving the prostate gland, such as radical prostatectomy for prostate cancer or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).¹&˒;² It can also occur, though less commonly, after pelvic radiation therapy. The development of scar tissue can be attributed to various factors, including impaired healing at the site of surgical anastomosis (the re-connection of the bladder neck to the urethra after prostate removal), hematoma formation, or reduced blood supply to the area.¹&˒;³ The primary purpose of understanding and defining BNC is to facilitate its timely diagnosis and appropriate management, thereby alleviating bothersome urinary symptoms and preventing further complications such as urinary retention, recurrent urinary tract infections, and bladder stones.¹
Clinical Context
Bladder neck contracture is primarily encountered in clinical practice as a complication following urological interventions on the prostate gland, most notably radical prostatectomy for prostate cancer and, to a lesser extent, transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).¹&˒;² It can also manifest after pelvic radiation therapy, where the underlying mechanism involves microvascular damage and progressive fibrosis leading to stenosis.² Patients typically present with lower urinary tract symptoms (LUTS) that develop weeks to months after the initial procedure, commonly within three to six months post-surgery.¹ Symptoms often include a weakened urinary stream, straining to void, incomplete bladder emptying, urinary hesitancy, an intermittent stream, dysuria (painful urination), and in some cases, complete urinary retention.¹ Recurrent urinary tract infections (UTIs) and the formation of bladder stones can also be associated with BNC due to chronic urinary stasis.¹
Patient selection for treatment depends on the severity of the contracture and its impact on the patient’s quality of life. Diagnosis is typically confirmed via cystoscopy, which allows direct visualization of the narrowed bladder neck, and may be supplemented by imaging studies like a voiding cystourethrogram (VCUG) or uroflowmetry to assess urine flow rate and post-void residual volume.¹
Surgical or procedural interventions are the mainstay of treatment. Common approaches include:
- Bladder Neck Dilation: This involves stretching the narrowed segment using dilators or a balloon catheter passed through the urethra. It may need to be repeated, and some patients may be taught intermittent self-dilation to maintain patency.²
- Transurethral Incision of the Bladder Neck (TUIBN): This endoscopic procedure involves making one or more incisions in the scar tissue at the bladder neck using a cold knife, laser, or electrocautery to widen the opening.² Adjunctive measures, such as injection of corticosteroids or mitomycin C into the incision sites, have been explored to reduce recurrence rates, though with varying success.²
- Bladder Neck Reconstruction: In refractory or complex cases where multiple endoscopic treatments have failed, more invasive surgical reconstruction of the bladder neck may be necessary. This is a complex procedure typically reserved for severe, obliterative stenoses.²
Expected outcomes after treatment are generally favorable in terms of symptomatic relief and improvement in urinary flow. However, recurrence of BNC is a significant concern, with a notable percentage of patients requiring repeat interventions.² Potential complications of treatment include bleeding, infection, urinary incontinence (particularly stress incontinence), and retrograde ejaculation.² The success rates vary depending on the initial cause of the BNC, its severity, the chosen treatment modality, and patient-specific factors such as comorbidities (e.g., diabetes, vascular disease, smoking) which can impair healing and increase the risk of recurrence.²