What is the bladder neck and why does it scar?
The cervix is a narrow transition from the bladder to the urethra, surrounded by muscle fibers of the internal sphincter. When urinating, it should open, allowing urine to flow into the canal.
If the cervical tissue is damaged - by surgery, inflammation, catheter or radiation - a scar ring forms in its place. It does not open completely, and urine comes out through a narrow hole: the stream weakens, the bladder has to work with effort.
There is also a primary, idiopathic variant - Marion's disease, in which narrowing occurs for no apparent reason, sometimes in young men.
Reasons
- TURP of the prostate and other endoscopic operations are the most common cause
- Radical prostatectomy
- Open adenomectomy
- Radiation therapy of the pelvic organs
- Long-term bladder catheterization
- Chronic prostatitis and cystitis
- Injuries of the pelvis and urethra
- Primary cervical sclerosis - Marion's disease
- Surgeries on the pelvic organs in women
Symptoms
- Weak, sluggish stream of urine
- The need to strain and delay in urination
- Feeling of incomplete emptying of the bladder
- Frequent urination in small portions and getting up at night
- Imperative urges
- Recurrent urinary tract infections
- Acute urinary retention
- Worsening urination months after prostate surgery - a typical scenario
How to distinguish between adenoma and urethral stricture
- Prostate adenoma - enlarged gland according to TRUS, narrowing at the level of the prostate; typical for older men
- Cervical sclerosis - the prostate may be small, and the narrowing is determined right at the entrance to the urethra; often have a history of surgery
- Urethral stricture - narrowing in the canal itself, a characteristic flattened curve on uroflowmetry and a typical picture on urethrography
- Neurogenic bladder - not the structure, but the control is impaired; detected by urodynamic study
The final answer is given by cystoscopy: the doctor sees the scar ring directly and assesses its density and extent. That is why, if there is difficulty urinating after prostate surgery, cystoscopy is mandatory.
Diagnostics
- Uroflowmetry - decrease in flow velocity
- Ultrasound of the bladder with determination of residual urine volume
- TRUS of the prostate - assessment of the size of the gland
- Cystoscopy is the main method of confirming the diagnosis
- Retrograde urethrography to exclude urethral stricture
- General analysis and urine culture
- Blood creatinine
- Urodynamic study if a neurogenic component is suspected
- PSA in older men
Treatment
- TUR of sclerosis of the bladder neck - resection of scar tissue through the urethra
- Transurethral incision of the neck - dissection of the ring at one or several points; less traumatic, often used for small prostate volumes
- Laser cutting
- Inserting a catheter for a short period after the intervention
- Trocar cystostomy - temporary diversion of urine when there is a delay or when endoscopic access is impossible
- Reconstructive surgery for recurrent forms
- Treatment of associated inflammation and infection
After surgery and prevention of relapse
- Control uroflowmetry and ultrasound with residual urine at the appointed time
- Contact a urologist at the first signs of weakening of the stream, without waiting for urinary retention
- Timely treatment of urinary tract infections
- Minimizing prolonged catheterization
- Observation for several years: recurrence of narrowing is possible and requires repeated intervention
- Quitting smoking affects the quality of tissue healing
Where is treatment in Tashkent
For diagnosis, cystoscopy is needed, and for treatment, an endoscopic operating room with the ability to perform a TUR or incision of the bladder neck is required.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Bring to your appointment statements of previous prostate surgeries: the very fact of intervention in the anamnesis sharply increases the likelihood of this particular diagnosis and speeds up the formulation. Clinic contacts are below on the page.
