Bladder neck obstruction

Edited by member 20 Jul 2014 at 20:06  | Reason: Not specified

Just had the camera in the penis this afternoon had had the same experience as you ,could not get the camera into the bladder. I recalled your post and asked if surgery to remove scar tissue was going to cause incontinense as I am at present dry, the registrar said as it was scar tissue it "should not " have an effect on continence as it did not work like muscle and sphincter. He said he would discuss with my surgeon/consultant but suggested if nothing was done it could stop me urinating altogether . My op was 28th April 2014 had a couple of bladder scans and the bladder empties fully, had one possible water infection and one definite infection three lots of antibiotics. Flow varies,fire hose discomfort and flow slows or full flow or slow flow or sprays like a garden sprinkler. Does anyone else have any experience of scar tissue removal and it's effect.

Thanks Chris

Hi Bri,

Father in law has bladder cancer and they stick the camera down his thingy every 3 months then a week later they stick a laser down there to zap them.

He has now been told that the laser struggles to get down and may need a op to make it easier,  now i am not sure how big these lasers are but it makes my eyes waterhttp://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-surprised.gif

of course he get lots of sympathy from me http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-surprised.gif  

Hope that helps, what was the question, no that doesn't help bugger

See you soon si

Over the years I have had 2 TURPS to remove scar tissue and they have never affected continence issues, why would they when the aim is to overcome that type of problem,. However on both occasions I had a urine infection which took some clearing. It is possibly only a coincidence but following both TURPS my PSA rose. This is of course most likely to be the effects of the infection. As a mere layman with no medical background, for me personally I would delay things as long as possible but I must emphasise that's only my take on things,

Best of luck,

Life is for living

Barry (alias Barrington )

Think the turps scar tissue and bladder neck scar tissue are different things. Please correct if I am wrong but, I guess your scar tissue is within the prostate were as Brian and myself no longer have a prostate and the scar tissue is were the bladder is joined back to the urether.

Thanks Chris

Quite strange today the flow has been much better and longer between visits to the loo,wonder if the camera moved some thing. Today was continuos flow then stop, no squirts no slow dribble. Seeing nurse led clinic next week 12 weeks post op and phone consultation with Incontinence nurse in couple of weeks. I suppose one slight concern is, do they make smaller cameras if we need to look inside the bladder. Will keep you informed.

Thanks Chris

Thanks for the info.

Brian, a bit slow at first then the penny dropped.

I do a fair bit of driving and post op started looking for toilets on journeys, I noted a lack of WCs , then I saw a sealable urine bottle in Boots so bought a couple. Keep one in the car just in case, not had to use it yet but it has measure scale on it,which was useful when doing the intake output for incontinence nurse and saves problems with the Yorkshire puds.

Read a bit about dilation treatment and get a bit concerned when it talks about attending A&E unable to pass urine.

I think I would like too plan what treatment and when rather than get what is given. Slow flow apparently is common 3-6 months post op and I am at 3 months post op. Brian I guess if your flow has been slow for a long time the opening has settled at an acceptable size.

I do have a slight kidney problem so not keen to store urine for too long.

Has anyone else had experience of other treatments for bladder neck scar tissue following RP.

Thanks Chris

Looks like I will have to answer my own question, flow rate was getting worse, frequency went up, when I say flow it was dribble and squirts. Got a call this morning can you come in Monday morning quick pr_ op then surgery in the after noon! not keen but Thursday morning thought it might be visit to A&E. Frequency every hour but only 100 mm or so (puds will have to taste strange a bit longer). Hope I am okay for Thursday or that will be another bi monthly support group meeting missed. Oh and possibly another UTI also on antibiotics again, GP say UTI should be gone for Monday.

First question Monday is it electric current.

Will let you know how it goes.

Thanks Chris

Now that's torn it just wet myself giggling, thanks for that Bri.http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-embarassed.gifhttp://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-embarassed.gif

BFN

Julie X

Had the the bladder neck stretched Monday lunch time, they got the camera into the bladder had a look round and found a plastic object in the bladder, that may explain the water infections. I was supposed to have a tap on the catheter after the night bag but because it was not written up I had to have a bag. Had to stop over night because there was a lot of blood in the urine. Went back to work today a bit sore and was by passing quite a bit, then total blockage for an hour all back to normal now. Big debate about who by and when the catheter was coming out but now booked for Sunday. Next step lets see what it has done to the continence, surgeon was confident it would not affect it.

Thanks Chris

Bri

Lyn / Bri

Sorry for the delay in replying. Not had Lego in the house for a number of years, we did go to Monte Carlo but lost all the chips, that left the plastic urine jug, then I realised we had Yorkshire puds so it was back in the cupboard.

Brian was close with the staples, I think.

It was a bit hectic when the surgeon told me what had happened, but three things I remembered were clip, haemorrhage and migration. It is my assumption it was plastic from seeing video clips of the op. I am unable to contact my surgeon at the moment, but may get some info Sunday when the catheter is removed.

My first instinct was that the clip had been left in by accident, but Bri’s comment got the grey matter working.

I have delved into google and found that a “Hem o lok clip” is frequently used in robot-assisted laparoscopic radical prostatectomy, what I cannot find is confirmation that they are routinely left inside or that they are used in the UK, or how big the clips are if used in the procedure.

On another site, which I cannot now find, it described typical symptoms of clip migration, frequent UTI, urine retention and at three months poor flow rate, which pretty much describes what I went through.

The following are links to old US National Library of Medicine National Institutes of Health, 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272559/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963780/

Extracts from of the links below

Of the 641 patients, 25 (5.7%), 1 (2.0%), and 2 (1.3%) had a bladder neck contracture after RRP, LRP, and RALP, respectively. Two RRP patients had a bladder stone. In total, 6 patients had surgical clip-related complications. Metal clip migration was associated with 2 (8%) of the 25 RRP cases of bladder neck contracture and both (100%) of the RRP cases of bladder stone. Moreover, both (100%) of the RALP cases of bladder neck contractures were associated with Hem-o-lok clip migration into the anastomotic site.

It appears that surgical clips are prone to migration and may cause, or significantly contribute to, BNC or the formation of bladder stones after radical prostatectomy. These findings raise questions regarding the use of foreign bodies in close proximity to the vesicourethral anastomosis during radical prostatectomy. At the very least, they indicate that care must be taken with the surgical clips used for inducing hemostasis near the apex of the prostate in radical prostatectomy. In addition, because the incidence of BNC after RALP is low, when unexplained voiding difficulty occurs after RALP, one should suspect that a Hem-o-lok clip has migrated, especially because Hem-o-lok clips cannot be detected on X-rays.

Thanks Chris

Bri

Had the catheter removed Sunday morning, came out mid afternoon, bladder almost empty just a few ml left. Was passing urine every half hour until about 2200, got up at 0030, then 0230, and then 0400 for work. Frequencey slowed to every 2 hours during the day but not a lot of volume, 125 ml. rough flow rate 8-12 ml/sec so vast improvement there. Solid stream then stop, but get the feeling I want to pass more. I had a couple of close calls but continence is still there. Early days so will see how it goes tomorrow, in the office all day. Nurses did not have any info on clips, so still in the dark over that one.

Thanks Chris

Bri

Had normal catheter in from Monday to Sunday then removed. No self cathetering  and frequency getting further apart.

Got to say the bag and catheter was a lot easier this time after a simple procedure rather than after the original op. 

Thanks Chris

Bit of a bummer Chris. I did read that some men needed the procedure again but not that quick. Hopefully as he says something to do with the catheter removal.
My flow is the same fortunately. There is someone else on here burtcan't remember who, who has had a decreased flow for years.

I'm having an ultra sound scan of my kidneys etc as in a Q&A session with another consultant he confirmed there is the potential for kidney damage with a reduced flow. Quite angry that my consultant didn't arrange this

Hope your next op is successful

Bri

Bri,

Just my experience, which may / may not be of interest. I was diagnosed with chronic urinary retention a couple of year ago.  At my maximum my bladder was retaining close on 2 litres.  This is no longer the case as I self catheterise, but it has left me with some kidney impairment and a floppy bladder (atonic?).

I had a Bladder Neck Incision (BNI) in 2013 - which didn't fix it then a TURP in 2014 which has improved things a bit but I still retain about 400 mls or more at the end of the day. The result is that I have to use an intermittent self catheter twice a day.  I have not had any UTIs so far (in one and a half years of using ISC) but I use sterile single use "no touch" catheters.

My understanding is that at the fill levels my bladder gets to now it is regarded as a low pressure bladder and so does not cause significant back pressure to my kidneys.  

It is the amount of urine retention that could potentially cause kidney issues after some time and 400 - 500 mls is full for a normal bladder.

So you really want to get your GP or Urologist to check your urine retention using an ultrasound scanner which they all seem to have now.

Martyn

Hi

Had another bladder neck stretch Monday 3rd Nov after getting down to a urine flow of 1.25 ml/ sec. Next step is a bladder neck incision if the latest stretch fails. Catheter fitted and to be removed Tuesday 11th Nov along with self catheterising instructions.

Wednesday morning woke with a swelling in the penis (thought the ED was cured) had the usual shower and clean but could not get the foreskin back over the end of the penis. By midday the swelling was worse and the foreskin was inflated like a balloon ( pictures available on request). Trying to get help from the district nurse took over 4 hours only to be told it was not her problem.

Our local hospital urology nurses came to the rescue, "get a bag of frozen peas on the penis until the swelling subsides, use a bit of lube and get the foreskin back over the end of the penis and keep using the frozen peas until the swelling goes down". Fortunately we had an ice pack so we still had veg with our dinner. Three or four hours later it was still tender but not swollen.

The surgeon still seems to think the stricture was caused by the way the catheter was removed, pulled out rather than slid out.

Thanks Chris

I have a picture in my head Chris, I can't get rid of it! Are you likely to be self catherising on a regular basis or is it just in case of urine retention? If you want any advice on ISC please send me a message, I do it at least three times a day and it's very routine now!

Thanks For the comments

Yorkhill

How long will I be self catheterising ? It is more for keeping the bladder neck open rather than urine retention, so it could be for some time.

Any insight and tips would be greatly appreciated, I have read a some of your posts on the subject but fore warned is fore armed.

This is the third time I have had a catheter in six months and not as comfortable this time.  When passing a motion get the feeling it is going to by pass but instead the penis swells, catheter is passing okay so not blocked , any ideas ?

Saw my ED guy yesterday he said the swelling was a good sign but keep off the pump until the stricture has been sorted. 

Thanks Chris

Carlos, it sounds to me like you need to try a different brand of pad, a stronger version of what you already have or should perhaps try the pants rather than the pads. You shouldn't be leaking onto clothing. What about Conveen sheaths?