This is a video of a patient who is s/p a prostatectomy and has developed a bladder neck contracture. He presented with diminution of his urinary stream. If a patient is voiding well after the prostate is removed and then the stream slowly decreases the likelihood is that he has developed a bladder neck contracture. The most common cause it is felt is that the mucosa of the bladder was not joined to the mucosa of the urethra and this in turn encouraged the formation of scar tissue or stricture. Strictures of the urinary tract are bad actors as they are perpetually are striving to heal in a closing concentric fashion which in turn narrows the urinary passage way and slows the stream at time to a dribble.
In this video I am using a cold knife urethrotome to incise the bladder neck contracture at 5 and 7 o’clock. In this particular case this is the second time I have had to do this and postoperatively I will instruct the patient how to self dilate using a catheter in which the frequency of which will diminish with time and hopefully allow the incised area to stay open.
In approximately 3% of patients who have had a radical prostatectomy will develop a scar where the bladder has been joined to the urethra after the prostate has been removed. This is a problematic condition and is manifested clinically as a slow stream. The most common form of treatment is either to dilate the area or to cut it either with a cold knife, laser or using electrocaudery. Some institutions offer reconstructive surgery for this disorder in refractory cases. If you are one of the unlucky patients that this happens to then it is another item to deal with in your prostate cancer journey and one that if at all possible you avoid.
The potential of this happening should be in the data base of the patient electing to have a prostatectomy and again highlights the importance of an experienced robotic urologist. In my opinion having an experienced urologist who has done a lot of prostatectomies do your surgery does not mean that a bladder neck contracture will not happen to you, but that the odds of it happening will be less.