Possible bladder neck restrictions caused by scarring after TURP

[Robert-Van-Elsberg]

  I had a TURP in November of 1997 and initially seemed to have good results. However, within a month or so after the surgery, I began to have urine retention problems again. When I went to the urologist who performed the surgery, he could barely pass a catheter into my bladder -- this was actually much harder and more painful than before the TURP. While the TURP had removed the blockage problems in the prostate, it appears (to me at least) that there has been scarring in the bladder neck which is now restricting urine flow. My urologist agrees but he tells me that a surgery to remove the scarring and improve urine flow could actually lead to worse scarring and a more restricted urine flow. At 46 years of age, I am really tired of getting up three-four times a night to urinate small amounts. This is hardly any better than before I had my TURP. Is surgery to remove the scar tissue in the bladder neck really as problematic as my urologist suggests? Are there any surgical techniques which show a good prognosis for success in alleviating this problem?

[hfhs M.D.-AK]

_
------------------------------------------------------------------------------------------------------------------------
Dear Robert,
Transurethral prostatectomy is a commonly performed operation in patients with clearly defined indications.  It is associated with a very low morbidity and complication rate.  The incidence of immediate postoperative complications is upto 18 percent.  The most common short-term complication is failure to void.  This can be due to a poorly functioning bladder, clots, or infection.  Long-term complications involve urethral strictures, vesical neck contractures and stress incontinence.
It is this long-term list of complications you should be concerned with.  A vesical neck contracture usually develops over years rather than months but nevertheless, could happen.  It is basically a scar right at the bladder neck.  When a scar on your skin contracts, it pulls the skin adjacent to the scar closer together.  A scar that is in the shape of a circle, narrows the center opening.  The symptoms are very similar to the symptoms you probably experienced before the operation, frequency, urgency, and incomplete emptying.
   A stricture could also explain your present condition.  It would involve difficulty urinating, particularly straining and dribbling.  This is a narrowing much like the vesical neck contracture, but in the distal urethra. A diagnosis of either of these conditions could be made by cystoscopy.
In terms of surgical procedures to correct this problem, a cystoscopy  and  possibly a retrograde urethrogram (X-ray with dye in the urethra) are necessary.  Depending on the position of the narrowing and the length of the narrowing several simple procedures could be done.  These procedures would all involve cutting the scar or resecting the tissue around the scar.  Most of these procedures are out patient and involve using a catheter during the healing process.  If the scar is more involved and longer, it may need to be removed in a more complex operation.
I think the next step is to perform a cystoscopy and bladder function testing if that is an issue.  Once you know what you are dealing with, then you and your doctor can discuss your options.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Stricture

[matt656]

A related discussion, Bladder neck post operation complcations was started.