Bladder neck stricture is caused by the formation of fibrous tissue (scarring) at the junction of the bladder and the urethra. It causes difficulty urinating, weak flow, or even acute urinary retention. It is usually a complication of previous prostate procedures performed with less advanced techniques that caused scarring, such as radical prostatectomy or transurethral resection (TURP).
Endoscopic treatment is a minimally invasive technique performed by urologists such as Dr. Angelos Economides, who has specialized training in endoscopic techniques.
These are called endoscopic procedures because no external incision is made on the body. The procedures are performed transurethrally, i.e. through the urethra, with the patient under general or regional anesthesia.
Such specialized techniques include:
- Optical Internal Urethrotomy / Bladder Neck Incision (BNI): The urologist inserts an endoscope and uses a special cold knife, electrocautery (current), or a laser beam (e.g. TFL laser) to make one or more incisions in the fibrous ring of the bladder neck, in order to open the lumen.
- Transurethral Bladder Neck Resection (BNR): Instead of a simple incision, a small amount of fibrous tissue is circumferentially removed around the bladder neck using a bipolar or monopolar loop.
- To avoid the main risk of recurrence, i.e. the bladder neck closing again due to new scar formation, during the endoscopic procedure there is the option of a local injection of medication that inhibits the formation of fibrosis.
The duration of the endoscopic procedure is short, with no incisions, minimal hospital stay (usually discharge the same or the next day), and rapid recovery. However, because the body tends to heal the area by forming scar tissue again, in some patients the stricture may recur, requiring either periodic dilations or a repeat endoscopic procedure.
After the endoscopic procedure, a urinary catheter needs to remain in place for a few days so that the area heals properly at its new diameter and re-stricture is avoided.
