Dr Jo Schoeman
Urological Surgeon

        

Trans urethral Bladder Neck Resection

Product Summary: AMA rates Bladder neck incision BNI, Mini-TURP

Item number: 36854, 105

For those guys with normal sized prostates, but with a prominent bladder neck causing all the irritating symptoms of an enlarged prostate (LUTS).

Why is it done?

  • This procedure is performed when the bladder neck has become stenotic (narrow) and tight, usually after a TURP, can also be found in the young man, with an overactive bladder neck.
  • Usually seen in the younger Type-A personality-type businessman who keeps his finger on the pulse of everything.
  • Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, kidney failure due to the weak urination (obstruction), bladder stones, recurrent bladder infections.
  • Medication such as Flomaxtra, Minipress etc. should always be given as a trial first. 
  • Prostate cancer first needs to be ruled out by doing a PSA and when indicated a 3T MRI scan is required prior to targeted prostate biopsies to exclude a malignancy.

How is it done?

  • Patients will receive a general Anastesia unless otherwise indicated.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigant (fluid).
  • The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
  • And incision of the bladder neck is made until a largely patent bladder neck is present. Using bipolar current.
  • Laser can also be utilized and is probably preferred due to lack of bleeding.
  • Prophylactic antibiotics will be given to prevent any infections.

What can go wrong?

  • Any anaesthesia has its risks and the anaethiatist will explain this to you.
  • You may in extreme cases experience blood loss, which may require a blood transfusion.
  • Please inform the practice and the hospital if you are a Jehovas witness, and cannot use blood products.
  • You will wake up with a catheter in your urethra and bladder. This will remain in the bladder for 1-3 days depending on the technique used and incidence of post-operatve bleeding.
  • You may have a continuous bladder irrigant running in and out of your bladder to prevent clot formation.
  • Lower abdominal discomfort for a few days.
  • NB! Each person is unique and for this reason symptoms vary!

What next?

  • You will spend 1-3 days in hospital.
  • You will a trial without catheter as soon as your urine is clear.
  • You will be discharged as soon as you can completely empty your bladder.
  • You may initially suffer from urge incontinence and will improve within the next 6 weeks.
  • Allow for 6 weeks for stabilization of symptoms.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Should your pathology be worrisome, you will be contacted for an earlier appointment.
  • Don’t hesitate to ask me if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side-effects

  • Retrograde ejaculation in more than 90% of patients. Therefore if you have not completed your family, this procedure is not for you unless absolutely necessary.
  • Infertility as a result of the retrograde ejaculation.
  • Stress incontinence especially in the elderly and the diabetic patients.
  • Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
  • Urethral structuring in 2-3% of patients, requiring intermittent self dilatation.
  • Regrowth of prostate lobes within 3-5 years requiring a second procedure.
  • NB! Each person is unique and for this reason symptoms vary!