“Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”…(Give Yourself a Second Opinion) 2001
Patrick C. Walsh, M.D.
Professor of Urology, The Johns Hopkins Medical Institutions and
Janet Farrar Worthington
Bladder neck contracture, or constriction of the bladder neck: this is scar tissue that forms where the bladder neck is sewn to the urethra, and it has been reported in between 1 and 12 percent of men after surgery. Its symptoms are usually manifested by persistent incontinence, and a very slow or dribbling urinary stream when –this is the tip-off—the bladder is full. Remember, incontinence immediately after surgery is a very common problem. In the early days after surgery, many men who are having incontinence also worry about having a slow urinary stream. But it’s hard to achieve a good stream if there’s not much in the bladder—and it’s impossible to store up urine in the bladder if it keeps leaking out. Bladder neck contracture is different; the bladder is full, but the best you can manage is a dribble, because the scar tissue is blocking the flow, like a stuck washer in a faucet.
If you are having prolonged incontinence, you should be evaluated with cystometry, a test that measures bladder progress and function by passing a small catheter through the urethra into the bladder. Changes in pressure are monitored as the bladder fills with water. If scar tissue is causing the trouble, it can be reopened in a simple outpatient procedure as a urologist, using a cystoscope (a tiny tube inserted through the tip of the anesthetized penis, through the urethra and into the bladder), makes a few tiny cuts to relax the tight scar tissue.
To keep the area open, your urologist may recommend that you pass a small catheter through the urethra every day for a month or so after the procedure. This way, the scar tissue won’t re-form, and the normal lining of the bladder and urethra will cover the opening as it’s supposed to. If the scar tissue is particularly stubborn, your doctor may inject a powerful steroid called triamcinolone into the area of the contracture; this can be effective in preventing the scar tissue from returning.