Recovering normal urination after a bladder neck incision

Hey Nick, 

Do you think your symptoms will resolve to normal; ie. before you had any problems? 

I was quite a young man when I had this op done, 20. It didn't really resolve my issues and more recently I have developed a strong sensation of being on the verge of peeing all the time. 

I am worried that the operation, for me, might have been a mistake and that I will always have this sensation of being in the verge. I haven't heard from anyone who's symptoms disappeared completely but that would help

Jack 

I reckon things should settle down Jack. My uro recommended the op as he said they find it's successful for most men. We're all different of course, but I think my frequency issues are starting to ease a little now.

Here's a couple of posts from other forums which I saved about the BNI op:

'I've had this operation twice, once in 2007 and again in 2014. The first time I had a bad bout of prostatitis beforehand, which was kicked off because I ignored the warning signs for years. After the operation it took me 9 months to start feeling good again, and two years before the discomfort went away completely. The second time was also preceded by a bout of prostatitis, again because I ignored my gradually decreasing stream and increased straining. I felt good about 10 months afterwards, and am still improving to date. My case isn't typical - most cases resolve in three months - but I wouldn't hang about on this. Just make sure you are comfortable with the side effects, which your surgeon should have advised you about.'

and another...

'I don't think I would have got better if I hadn't had the BNI, because when the Uro did the op he told me that my bladder neck had become very overgrown. Obviously this process had been going on for a long time and had just reached a critical mass. All I know though is that for the first time in my life I voided like a racehorse, with no split stream or dribbling and felt empty straight away. I felt 50% better straight off and everything else calmed down over 8 or 9 months as the surgical wound healed and the prostatitis fizzled out as there was no longer any perpetuating cause. There were a lot of ups and downs along the way - some pretty bad days - but it settled down to a low grumble, where all felt was a slight tickle or raw feeling in the glans now and then and maybe voided every three hours (which was remarkable for me - I used to think 90 minutes to 2 hours was normal) and once at night sometimes. So I had 12 months of hell pre-op, 8 or 9 months of gradually improving symptoms with many ups and downs, maybe a year of feeling 85% and then 5 years of feeling 90-95%. All of which was freakin' awesome. I'd get a flare every year or so lasting a few days to two weeks, but usually about a week where I would feel like my urethra was swollen, I had suprapubic burning and I'd need to pee every hour to 90 minutes (but always felt empty afterwards). No biggie.'

I'm not sure if you can add external links on this site so I hope the authors of the above won't mind me posting these. It's always good to hear positive stories from others!

 

Hi Peter,

I am supposed to go in for a BNI and am kind of scared.  How did yours go?  Any problems afterwords, how lng was your pain and recovery.  What about your flow?  Thanks for taking the time.  I am a bit scared and put this offer for years.  I am 39 and my flow is about a 9.  

Hi Joel.

If I hadn't of had two uti's before the procedure things would have been alot better, the antibiotics have messed up my digestive system and I have C. Diff infection.... But apart from my tummy trouble, now I am currently two months post surgery and my last flow test was 27ml/s and a residual of 40ml. Let's say I can pee freely. I still have retrograde ejaculations although reduced volume and sensations, the Dr said it will take time to adjust. During the day I now focus on filling my bladder up and getting a good strong urge before I void.. Remember to keep drinking.

The surgery went well and the pain was moderate. Was given endone in hospital and valium at home. The first 6 weeks are the worst, you will still have all your old habits and be worried that something is going wrong. But try to relax and have faith in your doctor.

Good luck.

Joel I wish I had of had mine done years ago. I was on tamsulosin for years and having uti forced the surgon to act. But I really do wish I had it done along time ago. But we can't turn back time.

Go get it done. You will not regret it.

Hi Peter,

I chatted with you a few years back when you first had your bladder neck incision. Hi

Would you share with me your outcome and if any complications now that some time has gone by? Did you get the results you were looking for? Would you do it again knowing what you know now. I followed you when you first posted this years ago and I have put the surgery off for almost 7 years now. I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. My bladder is becoming damaged and am again considering the surgery. Please share with my your experience. I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share as I would like to make a decision soon.

George.

Are you drinking enough? I had a lot of trouble because I wasn't drinking but i was always thinking I needed to pee. But in fact I didn't need to pee because I hadn't drunk enough water.

It takes a lot of time to to recover especially at your age. Take it easy try to relax and do some meditation

I had bladder neck contracture surgery yesterday following Holep surgery in May. Doc said it was an obstruction at bladder neck that will only allow me weak stream or trickle. Doc said good results would come right after catheter removal but not yet. Any idea how long fixing this might take or know how to find out?

I had bladder neck contracture surgery yesterday following Holep surgery in May. Doc said it was an obstruction at bladder neck that will only allow me weak stream or trickle. Doc said good results would come right after catheter removal but not yet. Any idea how long fixing this might take or know how to find out?

I had bladder neck contracture surgery yesterday following Holep surgery in May. Doc said it was an obstruction at bladder neck that will only allow me weak stream or trickle. Doc said good results would come right after catheter removal but not yet. Any idea how long fixing this might take or know how to find out?

Hi John

I'd give it a while. If you don't start to see improvements in two weeks I'd ask your doctor. But it can take up to 8 weeks to heal.

Make sure you drink plenty of water and urine alkalizer

Just my opinion, but 135ml of residual doesn't seem like a lot... I doubt if any guy over 60 fully empties their bladder when urinating... maybe your discomfort is from having more residual than YOUR usual?

I am at 750ml+ residual, Green Light procedure scheduled for later this month.

750ml residual is a lot. You should self cath before it even gets that high. Hank

Yes, I am thinking I need to cath at least 2X/day... maybe 10-12noon and 8-9pm...  I have been dealing with abdominal distension, my primary, uro and gastro Docs all have no clue as to why... IMO, it is my always full bladder not being able to process the amounts of water I drink daily, so the excess stays in my belly and distends it. (sort of like, DUH!)... no pain, no indigestion, no reflux. 

I will try cathing more and drinking less.

George, were you happy with your Green Light procedure?  How long to heal, pain, leakage, etc??  I have one scheduled, but my UroDoc has not discusses any other options, which concerns me...

IF your Green Light worked well, have you considered a repeat?  Seven years seems like a very good result...

The green light procedure I had 7 yrs. ago went well . with slight bleeding for several days after,.along with burning sensation. That Uro Dr. moved away, so when I asked my new Dr. about a 2nd Green light procedure, he told me that he only does the plasma button method which he thinks is more efficient with less bleeding involved. I took him at his word. In reviewing his Doctors notes, it stated he used the plasma button electrode to incise the bladder neck contracture with incisions at 5 and 7 oclock then same plasma button electrode was used for resection of right and left lateral lobes down to the level of the prostatic  capsule .Seemed like a lot more bleeding with this procedure and now, 9 weeks post procedure am just starting to see some positive results. Stream is stronger but not what I had hoped it would be. I get up about twice each night to pee which is a big improvement. I hope things will continue to improve over time. .

Best of luck with your condition and choice of procedures. It seems each Uro Dr. has their favorite method. 

George.

Thanks for the feedback, George... all the different procedures... very confusing...  did your Green Light procedure address the bladder neck when you had it done?  I think I have a BN problem, and for a LONG time (since my mid-late 20's, I am 62 now)...  Not sure if meaningful, but I feel a lot of resistance at the bladder neck when I cath... a fair amount at the prostate too, but nor nearly as much...

I'll do some homework on the plasma button (button TURP same thing?)... thanks again... I see my new UroDoc next week.

No, the green light procedure did not address bladder neck problem however that doctor did say I had symptoms of BN contracture at that time. I guess it got worse over the years. Please let me know what your new Uro doc recommends. I am guessing he would probably have to do a cystoscopy to see what is going on up there.

Good luck with your new guy. Hope all works well for you.

Thanks, George,  Odd, I would have thought that since your Doc was already "up there"... why not do a BN incision or two?  Yes, unfortunately, my new UroDoc will probably want to do a Cysto... I've had several and even though cathing does not cause me much discomfort at all, Cystos DO... I know, man up.  ;-) 

I think my BN got worse over the years too, but I am a little bummed that I always used to be able to pee normally, but weakly... then it got very slow, pretty suddenly... now, once I began cathing, I can't really pee at all... is this normal?  I hope my dang prostate didn't suddenly get a major growth spurt!

BTW:  I hope he will ask for an MRI and that insurance will approve it... I think that is the best way to really see what's what... I have been having some very unusual abdominal distension too... same time I slowed way down in peeing... probably related... maybe not... sure like to get both fixed!

I am now cathing 3X/day... getting some good volumes, though still don't have a measuring vehicle... maybe a bit too much... hate to have to go to 4X/day!  Thx again!

Thanks, Peter……your advice is very much on target. I had bladder neck contracture after HOLEP 3 weeks ago and peeing like I did at 18 (66 now). Pain is still there and frequency a little better each day. 3 weeks is probably too soon to see profound results but so far so good. I take it you agree that time is critical? Does anyone know if scar tissue can come back necessitating the BNI again? God, I hope not. Always worry when I pee if things are going to go south again.

Time and plenty of water are the key.

Scar tissue may come back but I guess it depends on what was the cause in the first place. Once I hit the 8 weeks all pain and issues had resolved. I'm still getting used to using my bladder correctly but at least I'm emptying fully.

Best of luck with your recovery.

hi Peter,

I had BNI procedure along with plasma button turp  10 weeks ago. Went home with catheter that was removed next day. First few weeks was passing some blood and small clots. Peeing flow rate improved and felt like I was emptying bladder pretty good. Only getting up twice per night. However things went downhill from there with some good days and bad days. bleeding has stopped. Now I am back to week stream , Getting up 4 or 5 times at night, No sleep. always feel like bladder is full.. I have been back to Uro Dr. 3 times, Bladder scans show residual urine ranging from 135 ml. to 200 ml. He thinks it is a week bladder muscle not pumping urine out. and that healing from procedure could take up to 6 months? I am frustrated to say the least. Starting to think procedure was not a success.

Maybe new scarring or a stricture is blocking flow. Have another Dr. visit tomorrow

Thanks for listening or should I say reading.

 

Hi George…..Hope you don’t mind my checking in. The recurrence of scar tissue is what haunts me too. I had bladder neck contracture about a month ago after HOLEP and every time I have to pee I’m afraid the really good stream will revert back to trickle mode. My URO doc is very non-communicative and can be harsh even sometimes. I think he’s torqued off that the HOLEP needed this extra follow up. I had total blockage 3 times which was holy hell and wound up in the ER in excruciating pain so I am very anxious to know if scar tissue can grow back and what’s the likelihood of that happening. Anyone weigh in?

Hi, George,  another question, if you don't mind... I had a couple of failures in using the 16 caths... I finally realize, I am too tight in urethra and prostate areas to use the 16's... even had a little blood last try... even the 14's I use successfully seem a little tight... should I try a 12?I assume the smallest diameter cath is the best... IF it does not leak... and with my tight bladder neck... I doubt if it would.  thanks for your help!

Hi George,

I was following you a few years ago when you first had your BNI. I know you metioned some issues with voiding even after. Did they clear up and did your voiding get better? Would you share with me your outcome and if any complications? Did you get the results you were looking for? I have put the surgery off for almost 7 years now. I am 41 years old and had a qmax score of 6 without any meds and 12 with meds. My bladder is becoming damaged /thick and am again considering the surgery. Please share with my your experience. I see some people have good flow after the surgery but then find out a few weeks later their slow flow comes back. Thank you for anything you can share as I would like to make a decision soon.