Bladder Neck Contracture

What is a bladder neck contracture?

Bladder neck contracture is a rare condition that may occur in men and people assigned male at birth after prostate surgery or prostate cancer treatment.

Your urinary bladder is a round, hollow organ in the lower part of your abdomen (belly) that holds your urine (pee). It expands like a balloon as it fills with pee. When you go to the bathroom, it shrinks back down. Your bladder neck is a narrow outlet at the bottom of your bladder. It’s where pee enters the tube that carries it out of your body (urethra).

Scar tissue can form after prostate treatments. The scar tissue causes your bladder neck to narrow (contract). This bladder neck contracture makes it more difficult to pee and can lead to conditions that affect your bladder and kidneys.

Which prostate treatments cause bladder neck contracture?

The following treatments may cause bladder neck contracture:

• Prostatectomy.
• Radical prostatectomy.
• Transurethral resection of the prostate (TURP).
• Radiation therapy.

Is a bladder neck contracture curable?

Yes, bladder neck contracture is curable. Talk to your healthcare provider if you have symptoms of bladder neck contracture after prostate treatment.

How common is this condition?

Bladder neck contracture is rare. Experts estimate that bladder neck contracture affects around 1 in 10 people after prostate surgery.

What are the symptoms of a bladder neck contracture?

Bladder neck contracture symptoms may include:

• Needing to push to start peeing.
• Pain while peeing (dysuria).
• Weak pee stream.
• Pee stream that starts and stops.
• Not being able to completely empty your bladder (urinary retention).
• Urinary tract infection (UTI).
• Bladder stones.
• Constantly leaking or dribbling pee (overflow incontinence).

Most people usually start to have bladder neck contracture symptoms three to six months after prostate surgery. You may notice that your pee stream gets gradually weaker. It’s easy to overlook at first, but it can progress to the point where you may not be able to pee at all.

What causes narrowing of the bladder neck?

Healthcare providers and medical researchers aren’t entirely sure why bladder neck contractures develop.

One possible cause is a complication after prostate removal. Your bladder neck connects to your prostate gland. During the procedure, your urologist reconnects your bladder neck to your urethra (anastomosis). A blood clot (hematoma) may form underneath or between your stitches (sutures) as you heal. The blood clot causes your sutures to stretch or even break, which causes gaps in the anastomosis. The gaps fill with scar tissue, which can cause the opening between your bladder and urethra to shrink.

Another possible cause is poor blood supply to the anastomosis. If your sutures are too tight, they can cut off the blood vessels near the anastomosis, which reduces blood supply and causes scarring.

Who does bladder neck contracture affect?

A bladder neck contracture can affect anyone who has surgery on their prostate.

However, if you have surgery on your prostate and have another condition that may cause poor blood flow — such as diabetes or heart disease — you may be more likely to develop a contracture in your bladder neck.

How is bladder neck contracture diagnosed?

If you have symptoms of bladder neck contracture, a urologist can make an official diagnosis. Urologists are healthcare providers who specialize in conditions that affect your urinary tract or reproductive system. They’ll conduct a physical examination and order tests.

What tests will be done to diagnose bladder neck contracture?

Your urologist may order the following tests to diagnose bladder neck contracture:

• Cystoscopy. During a cystoscopy, your urologist will pass a small tool with a light and camera at the end (cystoscope) through your urethra into your bladder. They’ll give you local anesthesia so you won’t feel any pain. They may also fill your bladder with sterile water or saline (salt water) to get a better look at your bladder.
• Cystourethrogram. During a cystourethrogram, your urologist will insert a small, flexible plastic tube (urinary catheter) through your urethra into your bladder. They’ll use the urinary catheter to insert a contrast dye into your bladder. They’ll then take X-rays of your bladder. The contrast dye causes your bladder to expand and makes it easier for your urologist to see details in and around your bladder.
• Voiding cystourethrogram (VCUG). A VCUG is the same procedure as a cystourethrogram, but your urologist will also take an X-ray while you’re peeing (voiding).
• Uroflow test. A uroflow test measures how well you empty your bladder when you pee.
• Post-void residual urine test (PVR test). A PVR test uses an ultrasound to measure how much pee is still in your bladder after you go to the bathroom.

How do you fix a bladder neck contracture?

Treatment options for a bladder neck contracture may include:

• Dilation. Dilation is a nonsurgical procedure that a healthcare provider can perform in a doctor’s office. They’ll insert tubes that gradually get wider through your urethra. The contracture will gradually widen (dilate) enough so that they can insert a urinary catheter to drain pee from your bladder.
• Transurethral procedure. This is a surgical procedure that your urologist will perform while you’re under anesthesia. They’ll use a type of cystoscope that uses an electric current to see the bladder neck contracture and remove scar tissue (resectoscope).
• Urinary reconstruction and diversion. In severe cases of bladder neck contracture, your urologist may remove all or some of your bladder. They’ll create a new way for pee to leave your body, usually through a small opening in your abdomen (stoma).

Can bladder neck contracture go away on its own?

No, bladder neck contracture doesn’t go away on its own. But if your contracture is mild, your urologist may recommend a “wait and see” approach. This means that you and your urologist will watch for any changes in your symptoms.

Your contracture is mild if it doesn’t harm your kidneys and you can completely empty your bladder without any problems.

How long does it take to recover from bladder neck surgery?

Most people recover two to three weeks after bladder neck contracture surgery. However, your recovery may be different. Your urologist will give you a better estimation of your recovery timeline.

Can a bladder neck contracture be prevented?

You can’t do anything to prevent a bladder neck contracture. It’s a rare type of scarring that may form after prostate treatments.

What can I expect if I have a bladder neck contracture?

The outlook for bladder neck contractures is good. However, scar tissue can come back and cause another contracture. Scar tissue may return if you have:

• Radiation therapy.
• Other procedures on your urethra.
• Problems during your first bladder neck contracture treatment.

If you develop another contracture, you may need another procedure.

When should I see my healthcare provider?

Talk to your healthcare provider if you have any symptoms of a bladder neck contracture after prostate treatment. You should also talk to your provider if you receive treatment for a contracture and develop new or worsening symptoms.

When should I go to the ER?

Go to the emergency room immediately if you:

• Can’t pee at all.
• Have severe pain in your stomach or groin.
• Are sweating a lot.

What questions should I ask my healthcare provider?

• How did I get a bladder neck contracture?
• What treatment option do you recommend?
• What’s the recovery time of your recommended treatment option?
• Will my bladder neck contracture come back after treatment?

A note from Cleveland Clinic

A bladder neck contracture is a rare condition that makes it difficult to pee. Symptoms go away for most people after treatment. However, a contracture can come back and require additional treatment. Talk to your healthcare provider if you have signs of bladder neck contracture after prostate treatment. They can make an official diagnosis and work with you to determine the best treatment option.