Bladder neck obstruction

Posted , 11 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

    There are many medication that could help relax the groin area that do not cause any side effects ask your doctor for one of them Voice your concerns

    Same with a BNI. Tell him you will only give permission for 1 cut because if you do 2 or more you will have leaking and you will end up with retro because the bladder neck will not close right.

    It is up to you what you have done. This is your body. Your the one that as to deal with the side effects.

    Take care....Ken

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    • Posted

      Hi Ken, thanks for the response.

      Not too concerned with retro, i can get passed this provided my flow is better and my bladder empties normally. I can handle dry orgasms as long as the sensation does not go away.

      My worry is more how long it takes to recover and that it is successful. The other side affects (incontinence etc are more of a worry).

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    • Edited

      Graham

      You have to think of the long hall. I have never heard of the orgasm changing as long as he does not touch the prostate but i still would only tell him one cut only. This would help and when should you have to give up anything your only 40.

      Recovering is different for every man but if you only have one cut it will be shorter for you. A BNI can take 8 to 12 week to heal. Sometimes it get worse before it gets better.

      Tell your doctor only one cut and see what happens. That may be all you need you can always go and do another at a different time if it does not work

      All the best....Ken

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    • Edited

      It is up to you what you do. You say that you don't care about retro. That is up to you. I'm 65 and when I had my prostate procedure at 58 that was one of the factors. I feel and there are other that see the ejaculation goes with the orgasm. Some also feel that it is not the same. You said that you can get use to it. But why should you.

      There have been men in there 70's that have refused procedure because of it.

      It is really up to you what you do. Maybe you will not have it. It all depends how how good your doctor is and where he does the cuts. Maybe if he does the cuts on the top of the bladder neck you will have as chance.

      Most cuts are done at 12-5 and 7. You have to talk to the doctor and tell him your concerns, Also this is not just up to you. You don't say if you are married. You have to talk with you partner and see what they think no ejaculation. Some women are still into it.

      Good luck and I hope you make the right decision.......All the best...Ken

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  • Edited

    I've tried:

    Tamsusolin + Betmiga - good effects for few months.

    Baclofen - only offer to use this, i didn't want to.

    So i decided to do BNI. You can check my journey with that here: https://patient.info/forums/discuss/bladder-neck-incision-your-experience--753683

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    • Edited

      Hi Pav,

      I'll have a look at your journey, thank you for sharing.

      Not overly keen on taking the drugs as I saw that the side affects (lethargy, heart palpitations etc) didn't seem to be worth the risk, especially as I'm quite active.

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  • Edited

    HI Graham. I was diagnosed with a bladder neck obstruction and Prostatitis. I had prostate pain, weak urine flow and frequent urination at night. I had a bladder neck incision surgery about 2 months ago and now my urine flow has dramatically improved. The pain from the surgery has all gone now. I still have some prostate pain associated with my prostatitis but my frequent urination symptoms have slightly improved. Also, I don't have retro ejaculation. Overall, the BNI was a good decision but not a total cure of my prostatitis yet. I hope this info helps.

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    • Posted

      That's amazing to hear. I do see a lot of bashing on here with regards to having the op for BNI. I am OK doing the self cath whilst at home and during lockdown but when life goes back to normal with traveling, socialising etc I feel it will be difficult to sustain the 4 caths per day!

      Re retro, for me at 40 my family is pretty much complete. I am not overly concerned if I don't produce liquid when i ejaculate, assuming you still get the sensation? I never really understood why this would be a major issue for men over 40? I understand if you are in your early 20s.

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    • Posted

      Hi I'm 49 years old and my average flow before the procedure was 5.2ml/s and peak flow was 8.0ml/s. My main symptoms were constant prostate pain which fluctuated in intensity and pain after ejaculation. After the BNI, my flow has improved but my prostate pain is still there. I'm going to get a semen culture done tomorrow to rule that out as a reason for the pain.

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    • Posted

      Hi Vick - thankyou for sharing, How did they diagnose Bladder Neck Obstruction.

      I had a cystocopy but they did'nt find obstruction from my enlarged prostate. or stricture, so diagnosed as 'possible' Primary Bladder Neck obstruction, ie does not open fully.

      I also have penile pain but so confused if my issue is bladder neck or prostaste or Over active bladder (or all 3)

      thank you

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  • Posted

    Graham,

    40 years old is young to get permanent retrograde ejaculation. You have a long way to go. If you want to see what RE feels like ask your doctor to put you on Tamsulosin (Flomax), that can cause it temporarily. If the single dose doesn't cause it ask for the double dose, two 0.4mg pills. After you see what RE is like you can go back to single dose or stop it all together.

    It sounds like you have an enlarged median lobe pushing into the bladder. Have you considered some of the other procedures like Rezum, Medlift (Urolift for median lobe), Ejaculation preserving TURP, PAE (Prostate Artery Embolization), FLA (Focal Laser Ablation) ?

    Thomas

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