15440 Bladder Neck Contracture

Overview

The bladder is a hollow organ that stores urine. Urine leaves the bladder through a narrow tube called the urethra. The bladder neck is the ring of muscle where the bladder meets the urethra. A bladder neck contracture is scarring and narrowing of this opening. It can make it harder to pass urine. It most often happens after prostate surgery, when scar tissue forms during healing.

It is not common in the general population. However, it is a known complication of prostate surgery, occurring in a small percentage of men who have their prostate removed or treated through the urethra.

The condition mostly affects men who have had surgery for an enlarged prostate (for example, a transurethral resection of the prostate or radical prostatectomy) or who had radiation therapy to the pelvis. It is very rare in women and children.

Symptoms

Common symptoms

• A weak or slow urine stream
• Feeling that the bladder is not empty after urinating
• Straining or pushing to urinate
• Urinating more often, especially at night
• A sudden, strong urge to urinate
• Dribbling after urination
• Repeated urinary tract infections

Causes

Main causes

• Scar tissue from prostate surgery (most common), such as TURP or prostate removal
• Radiation therapy to the pelvic area
• An injury or trauma to the pelvis or urethra
• Long-term inflammation or infection of the prostate or bladder neck

Risk factors

• Recent prostate surgery (within the last 6–12 months)
• Pelvic radiation therapy
• A previous bladder neck contracture
• Use of a urinary catheter for a long period
• Chronic urinary tract infections

When to see a doctor

See a doctor urgently if:

• You cannot urinate at all and your bladder feels full and painful
• You have high fever, chills, and vomiting with urinary symptoms
• You have sudden, severe pain in your lower belly or back

Book a routine appointment if:

• Your urine stream has become noticeably weaker or slower
• You feel that you are not emptying your bladder
• You have frequent urinary tract infections
• You keep getting up to urinate at night

Diagnosis

Your doctor will ask about your symptoms and medical history, especially any recent prostate surgery or radiation. They may then perform simple urine flow tests and look inside the bladder with a small camera (cystoscopy) to confirm the narrowing.

Tests that may be done

• Urine test to check for infection or blood
• Ultrasound scan to see if your bladder empties fully
• Uroflowmetry — a test that measures the speed and amount of your urine flow
• Cystoscopy — a thin, flexible tube with a camera that lets the doctor see the bladder neck
• Sometimes a urodynamic study to see how well the bladder stores and releases urine

What to expect at your appointment

Most tests are done as an outpatient. Cystoscopy can be slightly uncomfortable, but it is quick and usually done with local anaesthetic gel. You can usually go home the same day.

Treatment

Treatment aims to widen the narrowed bladder neck so urine can flow freely. The exact approach depends on the severity, your overall health, and whether the narrowing has come back after previous treatment.

Self-care at home

• Drink plenty of fluids (unless your doctor tells you otherwise) to keep urine dilute and reduce irritation.
• Avoid straining or pushing when urinating.
• Eat a high-fibre diet and avoid constipation, because straining can affect the pelvic floor.
• Pelvic floor exercises (sometimes called Kegel exercises) can help strengthen the muscles around the bladder, but ask your doctor or a continence nurse for guidance.

Medical treatments

Initial treatment is usually urethral dilation, where the doctor gently stretches the narrowed scar tissue using a dilator. Another common approach is cystoscopy and internal urethrotomy, where a tiny blade or laser is used to cut the scar tissue and open the bladder neck. Sometimes a urinary catheter is left in place for a few days to help keep the channel open. If the narrowing keeps coming back, you may be taught to pass a thin catheter yourself at regular intervals to maintain the opening. These procedures are done under local or general anaesthetic and are usually not major surgery.

When is surgery considered?

If a bladder neck contracture is very tight or keeps returning after simpler treatments, a more formal surgical incision (called a bladder neck incision) may be recommended. In rare cases, a reconstructive operation or a permanent urinary diversion is discussed, but this is only when other options have failed.

Living with this condition

After successful treatment, most people notice their urine stream improves quickly. You may have some temporary burning or light blood after a procedure, which usually settles in a few days. You will have follow-up appointments to check your symptoms and make sure the narrowing does not come back.

Lifestyle tips

• Stay active, but avoid heavy lifting or intense exercise for a few days after any procedure.
• Keep your fluid intake steady during the day to help flush your bladder.
• Do not ignore a weak stream or difficulty starting — earlier treatment can prevent serious complications.
• If you also have bladder leakage, wear absorbent pads and ask about pelvic floor physiotherapy.

Diet and exercise

A healthy diet with plenty of fruit, vegetables, and fibre helps prevent constipation — constipation can worsen urinary symptoms. Gentle exercise such as walking is fine. Pelvic floor exercises may help you regain control after a procedure; ask a specialist for advice on doing them correctly.

Mental health and emotional wellbeing

Living with urinary symptoms can be frustrating and embarrassing. It is normal to feel anxious, stressed, or low if this condition is affecting your daily life or sleep. Remember that most bladder neck contractures can be treated successfully, and speaking to your doctor about your feelings is an important part of your care.

Prevention

Because most bladder neck contractures are a complication of surgery, they cannot always be prevented. However, choosing an experienced urological surgeon, treating any urinary infection promptly, and avoiding prolonged catheterisation when possible may reduce the risk.

Complications

If left untreated

• Acute urinary retention — the complete inability to pass urine, which is a medical emergency
• Recurrent urinary tract infections and possible bladder stones
• Damage to the bladder muscles from long-term overwork
• In severe cases, backward pressure that can affect the kidneys

Long-term outlook

The outlook is usually good. Most people respond well to a simple dilation or endoscopic procedure, and only a minority need repeated treatments. The risk of serious long-term kidney problems is low when the condition is diagnosed and treated early. Even if the narrowing returns, modern endoscopic techniques are effective, and your medical team will work with you to find the best approach.

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