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Minimally Invasive Treatment for Severe Bladder Neck Contracture

Minimally Invasive Treatment for Severe Bladder Neck Contracture

Updated: 12/22/2015

For a handful of patients treated with radical prostatectomy, bladder neck contracture is a troublesome complication. This occurs when dense scar tissue forms in the bladder neck, the area where the bladder and urethra are joined together after the prostate is removed. The thickened scar tissue narrows the inside of the urethra, causing a restriction or a blockage of urine flow. The formation of this scar tissue may be caused by poor healing at the surgical site.

Simple Treatment for Mild Cases

Mild cases of bladder neck contracture are fairly simple to treat. During treatment, the urologist dilates the area using instruments passed through the urethra. If the contracture is more significant, the urologist passes a cystoscope through the penis and uses it to make cuts in the scar tissue. This helps break its stranglehold on the urethra. In rare cases, severe contracture can cause the urethra to become completely obstructed.

New Technique Replaces Major Surgery for Severe Cases

In the past, the only option for opening the obstructed urethra was major surgery. This was especially tough on patients who had just undergone radical prostatectomy. The recovery period could last for months and involved the long-term use of a catheter placed either in the urethra or directly into the bladder. Patients treated for severe bladder neck contracture also faced a high risk of impotence and long-term incontinence from the additional surgical trauma.

Researchers at Johns Hopkins Medicine developed a technique that avoids a second open surgical procedure and all the additional complications. During this procedure, the physician places small telescopes simultaneously through the penis and through a tiny incision above the pubic bone. Using this technique, physicians have been able to successfully reestablish the channel between the bladder and urethra using this minimally invasive procedure in all patients.

Once the urethra is reopened, the physician cuts the scar tissue using a laser beam to minimize trauma to the tissues. Then, over the next few months, he very gently enlarges the urinary tract until it is stable. The process may require several minor surgical revisions to treat additional scar tissue. During this time of healing, the patient must catheterize himself on a regular basis to prevent the opening from closing.

Using this technique, physicians at Johns Hopkins Medicine have been able to successfully treat most patients without major surgery and the devastating side effects of impotence and incontinence.


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