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Urology/Bladder Neck Contracture (Scar Tissue) post LRP

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Question
Hello,

I had LRP in July of last year (7 months ago) for prostatitis and I was recently diagnosed with a bladder neck contracture by my local urologist a couple of days ago. My urine stream has been getting weaker over the past few months along with feelings of incomplete urination & urgency. My dr. tried to use a cystoscope to look at my bladder but he couldn't get it through so he had to use form and followers (dilate) starting with a 12F, 14F, 16F & finally an 18F but that was as much as I could handle. Anyway, I have a procedure set up in a couple of weeks in which he will make a couple of incisions to open up the bladder neck & leave a catheter in for 4 days. He said the bladder neck opening should normally be a 26F, although I've read that an 18F or 20F can be normal. I've read that this procedure can be really helpful but I've also read that it can make incontinence worse. Anyway, does anyone have any experience with this procedure to open the bladder neck & if so, how much did it help/harm you? My urologist will most likely be using a knife instead of a laser & I really just want this to go away.

Thanks,

Hunter

Answer
Hunter:

If you do indeed have a bladder neck stricture, then it needs to be fixed surgically.  Bladder neck surgery does not make people incontinent since the external sphincter is still working and is not attached to the bladder neck.  Knife and laser work equally well but only about 50-60% of cases will heal completely OK.  The rest may develop another bladder neck stricture later.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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