Bladder Neck Incision Surgery in Delhi, India

1. Benign prostate hyperplasia (BPH) squeezing the urethra
2. Scarring for various reasons, including catheterisation or trauma from previous surgery, including Transurethral resection of the prostate (TURP).
3. Post radiation therapy for pelvic malignancies, including bladder, prostate carcinoma etc.
4. Bladder neck obstruction in women is uncommon; however, it can occur due to advanced age, menopause, multiple vaginal deliveries of babies etc.

1. Irregular flow of urine
2. Cannot fully empty the bladder
3. Increased urinary frequency
4. Increased urgency to urinate
5. Incontinence
6. Pelvic pain

Following tests are performed to diagnose BNO:

1. Retrograde Urethrogram

   If the patient has a history of previous prostate resection (TURP) and the doctor suspects that a bladder neck obstruction is present, they may use this test. In this test, images of the urethra are taken by using contrast imaging.

2. Cystoscopy

   This entails seeing inside the bladder with equipment known as a cystoscope. The doctor will insert a cystoscope into the bladder through the urethra during the endoscopic procedure.

3. Video Urodynamics

   During video urodynamics, X-rays or ultrasound are used to capture detailed images of the bladder in real-time. A small catheter will be placed to empty the patient's bladder. The catheter is to fill the bladder with fluid. When the bladder is full, the patient is urged to cough and urinate as much as possible. Thus, the images allow doctors to observe BNO as the bladder fills and empties.

4. Electromyography

   It involves recording the electrical activity of muscles of the urinary bladder and nearby sphincter muscles to detect any functional problems. This test is more frequently done in females.

BNO may be treated with medication or via surgical procedures such as bladder neck incision. The specific treatment plan will vary from person to person.

1. Medication(s)

   Medication(s) such as alpha-blockers drug therapy is usually the first step in treating bladder neck obstruction. They help by relaxing the bladder and neck muscles.

2. Surgery: Bladder Neck Incision

   A resectoscope is introduced into the urethra during the procedure. A resectoscope is a long, thin tube with a camera that allows doctors to observe the bladder neck better. After inserting the resectoscope, a cutting device (electric current/laser) attached to the resectoscope will make a small incision in the bladder neck wall.

• BNI is performed in symptomatic men suffering from BNO to enhance urine flow and reduce urinary pressure in the bladder. These urinary symptoms are caused by an obstruction in the bladder neck.
• When non-surgical treatment cannot improve the state of the bladder, bladder neck incision surgery can benefit the patient. The bladder can become permanently damaged or weak if the treatment is delayed for an extended time.

The patient will go through some routine tests. These tests are done before any surgery.

1. Routine Test

   Blood tests include complete cell count (CBC), complete metabolic panel (CMP), liver function test, kidney function test, etc. Tests like urinalysis are done to rule out infection before surgery. If the infection is present, it should be treated before surgery. An electrocardiogram(ECG) and X-ray are done to evaluate heart health. It assesses the heart to ensure it is safe during the surgery.

2. General Formalities

   Doctors and nurses will go over the risk of the procedure, and they will ask for the patient's consent to the surgery.

3. Avoid alcohol

   Avoid alcohol one week before and two weeks after surgery to avoid bleeding problems.

4. Stop taking blood thinners and pain medication

   The patient should tell the staff about all their medication and supplements. They will need to stop taking blood thinners and pain medication such as ibuprofen.

5. Fasting

   The patient may not eat or drink anything for at least six hours before the surgery.

6. Plan to go back home

   Following the surgery, the doctor will inform the patient about the length of their hospital stay. Because patients cannot drive themselves home after surgery, they must arrange for a vehicle and a companion.

General complications present during any surgery:

1. Pain
2. Bleeding
3. Infection
4. Allergic reaction to a medicine, anaesthesia, latex, etc.

Complications specific to bladder neck incision:

1. Retrograde ejaculation
2. Wanting to pass pee more frequently, as well as the unexpected impulse to pass urine
3. Stress Incontinence
4. Narrowing of the urethra