Bladder neck stricture
Below is a brief introduction to bladder neck stricture. Please always consult a doctor for an examination if you experience symptoms or suspect bladder neck stricture.
What is bladder neck stricture?
Bladder neck stricture is the limiting of the urine flow through the bladder neck, which impedes the body’s ability to pass urine. bladder neck stricture can occur in varying severity from light strictures with limited symptoms and some continued flow of urine, to complete and acute obstructions with severe symptoms and no urine passage. Symptoms or suspicions of bladder neck stricture should always be consulted with a doctor.
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What causes bladder neck stricture?
Bladder neck stricture can arise from a variety of causes but most commonly comprise of scar tissue resulting from surgery or long-term catheterization, sexually transmitted diseases, or physical injury. Bladder neck stricture may also be an undesired side-effect of prostatic resection (TURP) used as treatment against benign prostatic enlargement, or from prostatectomy used as prostatic cancer treatment.
How is bladder neck stricture diagnosed?
Diagnosis of bladder neck stricture typically involves analyzing the medical history to understand if any of the common causes have been observed, as well as general questions about symptoms. A variety of testing methods can also be applied ranging from MRI and CT scans, ultrasound measurements, as well as e.g. urethroscopy where a scope is inserted through the urethra to see if a stricture has occurred in the bladder neck.
Symptoms of bladder neck stricture
The symptoms of bladder neck stricture typically vary in magnitude depending on the severity of the stricture. If you are in doubt about whether you are experiencing symptoms, a doctor can examine and evaluate if treatment is necessary. Examples of bladder neck stricture symptoms can be seen below
- Difficulty in starting urination
- Interrupted and/or weak urinary stream
- Continuous feeling of having a full bladder
- Inability to empty the bladder completely
- Frequent urination especially at night
- Blood in the urine
What are the treatment options for bladder neck stricture?
The optimal treatment of bladder neck stricture typically depends on patient history, the severity of the symptoms as well as the length of the stricture. Below follow examples of how bladder neck strictures can be treated including examples of their respective advantages and disadvantages.
If the symptoms of bladder neck stricture are limited in severity and do not interfere with the patient’s everyday life, some doctors may prefer to simply monitor the condition and follow up frequently to evaluate the development in symptoms closely. Watchful waiting has the advantage of no side-effects or complications but comes with the risk that the condition is not treated in due time.
Balloon dilatation is typically the first method attempted to provide symptom relief. Balloon dilatation is generally performed under local anesthesia by means of a special balloon catheter which stretches the stricture to provide urine passage. Balloon dilatation is non-invasive, but often must be repeated regularly to sustain the passage and does cause risk of e.g. bleeding and infection.
The stricture can also be cut open by use of laser or a scalpel. Incisions are more invasive than balloon dilatation but typically provide longer term symptom relief. A catheter may be inserted through the stricture to hold open the gap after the incision, to allow it to heal. Though more effective than dilatations, some strictures reappear after a period, upon which a new incision or a different treatment can be performed.
Catheters are long plastic tubes plastic inserted through the stricture in the bladder neck to enable urine flow. Catheters can be single-use devices for self-catheterization, or indwelling catheters which are fixed in the body and exchanged approximately every 15-30 days. Catheters are less invasive than surgery but may also cause discomfort and pain to the user, affect quality of life, and carry a high risk of urinary tract infections.
Stents are short tubes fixed at the location of the stricture to allow urine to pass through. Stents are less invasive than surgery and affect the everyday life of patients less than catheters, but cause risk of obstruction from kidney stones, and may pass involuntarily through the urine. In either case the stents can be replaced by a new one or replaced with different treatment method.
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