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 About the Surgery

A Bladder Neck Incision (BNI) is an operation where an incision is made in the neck of the bladder to improve the flow of urine and to relieve urinary pressure in the bladder. The obstruction is removed through a telescope that is inserted up through the urethra to your bladder neck.

 Aim of Surgery

Removing the obstruction improves urine flow and associated symptoms and prevents complications such as complete blockage, urine infections, bladder stones and kidney damage.

 How Long is Surgery

30-60 min

 Anaesthetic

General anaesthesia

OR

Spinal anaesthesia (injection in the back)

 Incision/Cut

· No skin incisions – the entire operation is performed through the opening of the penis and all incisions are made internally

 Description of Surgery

The surgeon passes the telescope through the urethra into the bladder. The blockage can be seen and surgically removed with a small knife instrument that has been passed through the telescope. When the obstruction has been removed, a catheter tube is inserted into the bladder and fluid washed in and out to help settle any minor bleeding and to irrigate the bladder.

If you have had previous prostate surgery (TURP), resulting in scarring of your bladder neck, the surgeon may also remove any regrowth in prostate tissue whilst doing a BNI to ensure an open channel.

 Complications of Surgery

·Urinary frequency, urgency and/or burning - common and usually does not last longer than a few weeks after surgery

·Infection - usually responds to tablet antibiotics

·Bleeding - very rarely significant

·Pain

·Damage to ureter and bladder - very uncommon

·Absorption of excessive fluid used to assist vision during the procedure("TURP syndrome")

·Anaesthetic problems including allergies, breathing and cardiac problems, deep vein thrombosis (clots in legs)

·Long term complications (rare) include:
- impotence (2-4%)
- retrograde ejaculation whereby ejaculation goes back into the bladder (5-15%)
- urinary incontinence (<1%)
- strictures (ie further scarring) of the urethra or bladder neck (1-2%)

·Not able to pass urine – due to clots, swelling of bladder or bladder weakness requiring reinsertion of the urinary catheter for up to 2 weeks.

·Injury to rectum (very rare)

 Duration of Hospital Stay

1-3 nights - depending on extent of surgery and degree of bleeding after surgery