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Urology (Expert Forum)
Raised Bladder Neck
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Raised Bladder Neck
by Scojo, Jun 12, 1998 12:00AM
I am 35 years old and have a lifelong history of hesitancy. Post void dribbling is my greatest concern. Within the last 7 years, I have a history of prostate infections. I recently saw a urologist who thinks (not an absolute diagnosis) I might have a raised bladder neck. I under went an ultra sound on my bladder after voiding. I felt like I had urniated completely, but then agian, maybe I don't really know what that feels like. According to the ultrasound, I still had approximately 5 ounces of urine left in my bladder.
In the past, I have seen other urologists and none ever mentioned the possibility of a raised bladder neck. This is the only diagnosis I've received that links to my lifelong history of hesitancy. I've had a cystoscopy and was told I had no scarring and everything looked ok.
Obviously, I don't want to have the symptom of post void dribbling and all the rest of the mental/emotional problems that go along with that symptom. I was told a trans-urethral incision would eliminate (pardon the pun) this problem. However, there is a 20% chance of developing a retrograde ejaculation associated with this procedure. This is a chance I can't afford to take. I plan to have more children. Also, my wife said that a dry ejaculation does not sound like much fun. I agree. Any advice/insights provided will be greatly appreciated.
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Dear Scojo
Here is the follow-up I promised. We recommend trying an alpha blocker. A selective alpha blocker, Flowmax or Tamsulosin is claimed by the manufacturer to have a lower side effect profile in younger men than other alpha blockers. If you can not tolerate this medication, we would recommend surgery but would be less aggressive. Our experience with retrograde ejaculation after bladder neck incision is about 20% in our last 20 patients.
2 of these 20 men were interested in preserving antegrade ejaculation for childbearing reasons. We purposefully offered them a less aggressive incision. Their improvement in flow and symptomatology is remarkable. We have not asked our other patients with retrograde ejaculation to try psuedephedrine ( on over the counter cold medication) which helps men with idiopathic retrograde ejaculation.
Hope this has helped.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely;
HFHS-M.D. MS
* Keyword: bladder neck incision, primary bladder neck obstruction
