Bladder Neck Incision

Subject: BNI

Greetings!

I'm trying to verify information I received from my urologist before I make the decision to have BNI.

Briefly:

In 2003 I underwent a radical prostatectomy for cancer.  Early stage.  All PSA tests negative for 5 years.

Two months after surgery I stopped urinating, caused by a stricture.  It was opened using a balloon procedure.

This was followed by 1.5 years of intermittent self-catheterization (16 French coude tip), twice a day, to keep the urethra open--after which I stopped.

I had no problem urinating until 6 months ago when a "reverse" problem developed: periodic incontinence.  It began after I moved extremely heavy objects and felt pain in my lower abdominal area.  My general doctor said there were no external hernias upon examination.  Then, a few dyas later, when I was resting in a recliner chair, I work up with a wet spot.  For several evenings I "wet to bed."...  But not every night.  I suspected that I injured bladder muscles.

I noted what seemed to be a gradual low flow in my daily urination, so I saw a urologist.  Knowing my previous problem with a struicture, he "opened" the urethra in his office using gradually larger sounds up to 18 French.  When he cystiscoped me he commented that there was a flap of tissue blocking the urethra.  I think this has been there for the 5 years since my prostatectomy, and questioned whether this was the new problem.  At this point he recommended a BNI.  After the opening procedure in his office, I have used 18 French catheters twice a day (LoFric hydrophilic).

For several weeks after the opening of the urethra my urination was "normal"---no incontinence nor low flow.

Now, even though I self-cath to keep the urethra stretched, I find I "leak" and have had (while sleeping) incontinence on some nights.  The urologist still thinks that I need a BNI even though the problem is incontinence and not blockage.

My question: Why would a person have a BNI when the current problem is NOT low flow or blockage but rather periodic incontinence and wetting?

Thanks for any insights you can provide.

Dr. Robert Hill
University of Georgia
College of Education

[riley180]

Hi Bob,
You are correct that the bladder neck incision is used generally if the problem is obstruction. I do not wish to take away anything from your doctor, but the simplest (perhaps the silliest) explanation may be that he meant bladder neck sling (what do they call that, I think its “Presque vu”). A closer term would be a bladder neck suspension – but this is generally done in women.
It should be emphasized though, that not all incontinence is free of obstruction. There is an overflow incontinence, in which there is an obstruction and pressure gradually rises. Once sufficient pressure is present, the urine spills past the obstruction. In this scenario, the BNI may be helpful. Your urologist may suspect that the flap is acting as an obstruction.
It may be helpful to perform a urodynamic study, to settle the issue.
My best to you.