Urology/hypotonic urinary bladder, ISC, TURP and recurrent bladder neck constricture.
I am a patient with hypotonic urinary bladder due to narrowing of bladder neck.ISc 5 times a day was recommended during may 2012. after 3 months of ISC i developed difficulties in the insertion of cathter. As per a senior urologist advice TURP and BNI operation was performed during july 2012. However insertion problems reoccurred five months after surgery and i have to drop from 14f to 10f without much benefit.
On August 8 2013, cystoscopic evaluation revealed elevated bladder neck,distorted , clearly obstructive to the passage of catheter.There was a short flame passage above verumontanum and partial narowing in bulbar urethra. Bladder neck including the area of false passage and urethral narrowing were were incised. Patency was confirmed on table with 18f cath. Discharged with catheter and removed after 5 days.
Immediatly after catheter removal and for 15 days after surgery self catheterisation was freely performed. but from 16 day onwards it became very difficult to pass the catheter which is presently possible only after voiding small quantities of urine.Short urinations appears to relax the bladder neck and permitting the catheterisation with 14 /12 f with acceptable ease.
I contacted my urologist who adviced for cystoscopy and a procedure that can dilate the narrowing if any.
Iam a worried man as the problem of easy ISC is unsolved even after two major surgeries that too very early after second surgery.what is the prognosis in my case ? is repeat surgery though a minor procedure as per my urologist going to solve the problem for time being? what are the possible complications Please advice the course of action for which i will be grateful.
Ramakrishna, if you have not tried a coude catheter before, this might be the simplest solution. There is often a small lip at the inferior aspect of the bladder neck from scarring that makes passage of a regular catheter sometimes difficult. A coude catheter is a regular catheter except it has a curved tip. It is inserted with the curve pointing backwards (toward the scrotum) so that when it reaches the bladder neck, the curve should allow it to ride over the lip and into the bladder. I have also found that inserting a catheter (any type) to level of the bladder neck and then stopping, take a deep breath in, and then let it out slowly. While exhaling, the bladder neck relaxes making it easier for the catheter to pass into the bladder.
Further surgery should be the absolute last resort as you may end up with additional scarring as it heals. If it is absolutely necessary, I would suggest a "cold knife incision" rather than traditional electrocautery or lasers to minimize further scarring. The placement of a suprapubic tube be an easy option but this would require wearing a bag, having the catheter changed at least every 4 weeks, and then there is the potential for malodor and infection.
If all else fails, ask you urologist if you are a candidate for a bladder pacemaker. Another option would be a bladder diversionary procedure. However, try all simple measures before considering these.