What is contracture of the bladder neck?

Contracture of the bladder neck is a rare condition that can occur in men after prostate surgery. Various telescopic procedures are commonly performed for benign enlargement of the prostate, known as benign prostate hyperplasia. This condition may be treated with medication or by telescopic surgical removal of a portion of the prostate gland. Following such surgical procedures on the prostate, a bladder neck contracture or scar tissue can form at the junction of the bladder outlet and the prostate. The prostate gland is located between the bladder and the urethra, the tube through which urine leaves the body.

For individuals who have prostate cancer, one treatment option is the removal of the prostate. If the prostate gland is removed, the bladder neck, which had been connected to the prostate, is reconnected to the urethra, the tube through which urine leaves the body. This connection is called an anastomosis. In rare cases following prostate surgery, fibrous connective tissue replaces the normal muscle tissue of the bladder neck. The scar tissue at the site of the anastomosis may cause the opening between the bladder and urethra to narrow or to close completely.

In very rare situations, a bladder neck contracture may lead to more serious problems, such as bladder or kidney damage.

What are symptoms of contracture of the bladder neck?

Men usually begin to experience symptoms of bladder neck contracture within 3 to 6 months after prostate surgery. At first, a man may notice a gradual reduction in the flow of urine. This symptom may be overlooked at first, and can progress to the point where he becomes unable to urinate. In other cases, a man might experience urine leakage when the bladder becomes too full. This condition is known as overflow incontinence. Some of the symptoms associated with contracture of the bladder neck include:

  • Needing to push to begin urination
  • Delayed onset of urination (following the urge to urinate)
  • Slow or diminished force of urine stream
  • Urine stream that starts and stops
  • Sensation of incomplete emptying

What causes contracture of the bladder neck?

No one is completely sure why bladder neck contractures develop. One possible cause is gaps in the anastomosis or surgical connection of the bladder neck to the urethra. After surgical removal of the prostate, a blood clot called a hematoma may form underneath or between the surgical sutures (stitches), causing them to stretch. The stitches may break or tear. In either case, gaps may form in the anastomosis, which tend to be filled by fibrotic or scar tissue. The scarring can cause the opening between the bladder and urethra to become narrower, resulting in the bladder neck contracture.

Poor blood supply to the anastomosis may be another possible cause. Stitches that are too tight can cut off the blood vessels near the anastomosis, reducing blood supply to the site. Some medical conditions, such as diabetes and heart disease, are associated with poor blood flow, so men with these diseases may be more likely to develop bladder neck scarring. Bladder neck contractures tend to occur more often in older men than young men for similar reasons.