Bladder neck obstruction

Posted , 5 users are following.

Hi all, I'm new to the forum and wanted to share my story. I am also in a dark place as I feel like I don't know where to turn or what the right decision is to make.

I'm approaching 40 years old and was recently diagnosed with a number of lower urinary tract symptoms. A CT scan revealed I have a abnormally elongated urinary bladder with a trabeculated wall. A flexible cystoscopy was performed and it was noted my prostrate was mildly occulsive, and showed a high bladder neck with non-occlusive lateral prostatic lobes there was a spasm at the bladder neck, which was somewhat high.

In addition to the above, I also had a urodynamics test done and this revealed a poorly compliant bladder (pressure of 27cmH20 at an end-fill volume of 229ml) and extremely high voiding pressure (100cmH20). The maximum flow was reduced at 9.9ml/second and had a post-void residual of 700ml.

My options have been the following:

  • Perform clean-intermittent self-catheterisation (to preserve bladder function).
  • try medication (tamsulosin) to try to improve urinary flow and bladder emptying (with the level of obstruction it's unlikely to provide a good and safe long-term solution).
  • Bladder neck incision (this would be the most definitive way to improve his bladder

    emptying and reduce his voiding pressure over time back towards a normal level).

My concerns are:

I have gone from twice daily to 4 x daily with ISC and I'm not a fan of doing this long term.

The side effects of Tamsulosin have put me off this method so I have not attempted to take this.

BNI only seems to be the most appropriate form of fixing this long term and I'm aware of this risks with retro-grade ejaculations. I'm not entirely fussed about that option, i'd just rather be able to flow and empty bladder properly and live a life where I'm happy again. I've had a serious bout of depression since the diagnosis in December last year and struggling to come to terms with ISC long term.

To give some context, my NV is anywhere from 50-200mls and PVP is anywhere from 400-600. On Average it's around the 100ml - 500ml mark.

Any thoughts would be most welcome, thank you!

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  • Edited

    I have bladder neck obstruction as well as urethral stricture at the age of 25. My condition hasn't reached as bad as yours yet. However, I have extreme delay in starting urination. My flowrate is just 4 m/s at the moment which is actually in the danger zone but my PVR is around 50 ml. I am controlling this problem by taking Tamsulosin 0.4mg and it is giving me very low level of energy and severe depression.

    You should post this in the prostrate section of the forum. There are many BNO members there.

    You could get TUIP done or ejaculation sparing bladder neck incision. I am not sure how long both of this will last though. So, please do a lot of research before you opt for the surgery.

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    • Posted

      Hi Hamza,

      Sorry to hear about your condition at such a young age.

      That was the issue i faced with being offered Tamsulosin, I did not want to be low energy as I'm active day to day (gym etc).

      I'd be extremely happy with your PVR as that is nothing (50ml), in fact that is totally normal. Mine is anywhere between 400-600mls.

      I've not heard of TUIP or have been offered that by my urologist so interesting that this is an option that has not been offered.

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  • Posted

    Wow. We have almost the same symptoms and age. I had a cystoscopy about a year ago revealing trabeculation and a tight bladder neck. Prostate is basically normal, but I know my bladder is large because it can fill to at least 1300ml without me waking up! I've been feeling very alone in this problem, since it seems to be common only in people much much older, or with other conditions (diabetes, MS, Paralysis). So hey, at least we've got eachother...

    I have been doing CIC 5x per day, with a PVR of around 400 unless I really relax and press on my bladder, in which case I can get it down to 250-300..

    I was taking tamsulosin for a few months but that didn't seem to help. I did urodynamics on a machine that only fills to 750ml and I didn't feel anything (when sitting I really have lack of sensation... it improves if I stand up and usually I can tell when I'm at like 400-500ml if I press on my bladder slightly.

    After a year of this nonsense I haven't noticed any improvement. Urology just says come back in a year for more urodynamics. I have another ultrasound in a few months (probably yearly) just to make sure I'm not damaging my kidneys. Primary Care doctor has 0 advice.

    If I had better insurance or more money I think I'd find someone to consult with about a detrusor myoplasty, but it sounds complicated and rare.

    I wish I had some good advice, but I'm looking for some myself!

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    • Posted

      Hi,

      You have said after 1 year you haven't noticed any difference?

      Did the urologist advise you would see a difference then?

      I wasn't advised that CIC would improve things, it was more about ensuring I wasn't going to do anymore damage i.e. protect kidneys. Urologist said to me that even if I have the operation, it would still be likely that I would need to self cath at least twice daily and then assess it on an on-going basis. I don't believe this is a quick fix.

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  • Posted

    Long term is effective but the thing you should do is pace yourself medically and healthy wise over that time.

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    • Posted

      I think that is what the CIC is supposed to do. I have still not yet decided to go ahead with the procedure yet....I have done one year of self cathing. Whilst is is a pain to keep doing (especially when out) it does ensure that i am not making any mistakes etc.

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