Surgical option: Bladder neck incision

 

This operation is carried out on a man's bladder neck which has narrowed with minimal Prostate enlargement or after a prostate operation e.g TURP or laser prostatectomy, where scarring has caused a narrowing. The bladder neck incision (BNI) is to relieve the symptoms caused the narrowing and obstruction to urine flow.

 
 

What is a bladder neck incision?

 

This operation is carried out on a man's bladder neck which has narrowed with minimal prostate enlargement or alternatively after a prostate operation to relieve his symptoms which has resulted in scarring which has caused the narrowing for example after TURP.

26/4/2010 | 4Urology Administrator
 

Video on BNI

 

26/4/2010 | 4Urology Administrator
 

Why do I need a BNI?

 

If you have narrowing of the bladder neck at the level of the prostate, but this is not mainly due to an enlarghed prosate, then you should benefit from a bladder neck incision if you have symptoms of obstruction. Urologists call this bladder outflow obstruction. It is not serious but can cause problems with urination. You may:

  • Go to the toilet more frequently and need to get up at night
  • Have to strain to pass urine
  • Need to get to the toilet more quickly but find the flow is weak and stops and starts
  • Leak urine


Not everyone needs an operation but it is usually recommended if:

  • Your bladder does not empty properly, causing infections in the urine left behind
  • You stop passing urine altogether (acute retention of urine)
  • Your symptoms are very troublesome and medication has not helped
  • You have bladder stones because the bladder is not emptying properly

Following the operation you should have:

  • A stronger stream without the need to strain
  • More control over when you urinate and need to go less often and less urgently
  • Your symptoms will be less likely to interfere with your normal activities and you should not have to worry about being close to a toilet at all times
26/4/2010 | 4Urology Administrator
 

What are the alternatives to this procedure?

 

If the bladder neck incision is for a small prostate the realistic alternative options may include drugs. If these fail you could have a longterm catheter or possibly a prostatic stent.

If your symptoms are mild observation is an option. If the obstruction is due to a large prostate alternative options include open or laparoscopic operation or laser enucleation of the prostate (HoLEP).

15/9/2010 | Paul Sheffield
 

What should I expect before a bladder neck incision?

 

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits.

You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.

You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your Urologist in advance of your surgery if you have any of the following:

an artificial heart valve
a coronary artery stent
a heart pacemaker or defibrillator
an artificial joint
an artificial blood vessel graft
a neurosurgical shunt
any other implanted foreign body
a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®)
a previous or current MRSA infection
high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone)

15/9/2010 | Paul Sheffield
 

What happens during a BNI?

 

 Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.

You will usually be given injectable antibiotics before the procedure, after checking for any allergies.

The prostate and the neck of the bladder are incised using a metal "spike" to relieve the obstruction (see below). A catheter is placed in the bladder to allow irrgation with saline solution which prevents the development of blood clots in the bladder.

Bladder Neck Incision

1/7/2010 | 4Urology Administrator
 

What happens immediately after a BNI?

 

 There is always some bleeding from the prostate area after the operation. The urine is usually clear of blood within 12 hours, although some patients lose blood for longer. It is unusual to require a blood transfusion after bladder neck incision.

It is useful to drink as much as possible in the first 12 hours after the operation because this helps the urine clear of blood more quickly. Sometimes, fluid is flushed through the catheter to clear the urine of blood.

You will be able to eat and drink on the same day as the operation when you feel able to.

The catheter is generally removed at midnight on the first night after surgery. This allows your bladder time to fill overnight so that, in the morning, the doctors can decide whether you can go home without the catheter At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few weeks. Some of your symptoms, especially frequency, urgency and getting up at night to pass urine, may not improve for several months because these are often due to bladder overactivity (which takes time to resolve after prostate surgery) rather than prostate or bladder neck blockage. It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. Some blood may be visible in the urine even several weeks after surgery but this is usually not a problem.

Let your nurse know if you are unable to pass urine and feel as if your bladder is full after the catheter is removed. Some patients are unable to pas urine at all after the operation due to temporary internal swelling within the prostate area. If this should happen, we normally pass a catheter again to allow the swelling to resolve and the bladder to regain its function. Usually, patients who require re-catheterisation go home with the catheter in place and return after a week or so for a second catheter removal which, in almost all cases, is successful.

The average hospital stay is 2 days.

1/7/2010 | 4Urology Administrator
 

What should I expect after being discharged?

 

 Most patients feel tired and below par for a week or two because this is major surgery. Over this period, any frequency usually settles gradually.

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

1/7/2010 | 4Urology Administrator
 

What else should I be aware of?

 

  If you experience increasing frequency, burning or difficulty on passing urine or worrying bleeding, contact your GP.

About 1 man in 5 experiences bleeding some 10-14 days after getting home; this is due to scabs separating from the incision in the bladder neck. Increasing your fluid intake should stop this bleeding quickly but, If it does not, you should contact your GP who will prescribe some antibiotics for you. In the event of severe bleeding, passage of clots or sudden difficulty in passing urine, you should contact your GP immediately since it may be necessary for you to be re-admitted to hospital.

 Bladder neck incision of your prostate should not adversely affect your sex life provided you are getting normal erections before the surgery. Sexual activity can be resumed as soon as you are comfortable, usually after 3-4 weeks.

It is often helpful to start pelvic floor exercises as soon as possible after the operation since this can improve your control when you get home. The symptoms of an overactive bladder may take 3 months to resolve whereas the flow is improved immediately.

If you need any specific information on these exercises, please contact the ward staff or the Specialist Nurses.

Most patients require a recovery period of 2-3 weeks at home before they feel ready for work. We recommend 3-4 weeks’ rest before resuming any job, especially If it is physically strenuous and you should avoid any heavy lifting during this time.

  

1/7/2010 | 4Urology Administrator
 

When can I drive again?

 

 It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than 3 months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

1/7/2010 | 4Urology Administrator