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Bladder Neck Incision (BNI)

Overview

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Bladder Neck Incision (BNI) is a minimally invasive surgical procedure aimed at improving urinary flow by making small cuts at the bladder neck, the area where the bladder connects to the urethra. BNI is commonly performed for patients with bladder outlet obstruction (BOO), which can result from conditions like benign prostatic hyperplasia (BPH) or scarring around the bladder neck (bladder neck stenosis). The primary goal of BNI is to reduce obstruction and alleviate symptoms such as difficulty urinating, frequent urination, or incomplete bladder emptying.

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How is Bladder Neck Incision done?

  • Preoperative evaluation: A thorough medical history, physical examination, and diagnostic tests (e.g., uroflowmetry, ultrasound, cystoscopy) are required to assess the severity of bladder outlet obstruction.
  • Medications: Blood thinners may need to be stopped several days before the procedure to reduce bleeding risk.
  • Fasting: Patients are usually required to fast (not eat or drink) for at least 6 hours prior to surgery.
  • Preoperative clearance: In some cases, routine blood tests, ECG, and chest X-rays are needed to assess overall health and fitness for anesthesia.

  • Anesthesia: The procedure is typically performed under general or spinal anesthesia, depending on patient preference and clinical conditions.
  • Cystoscopy: A small telescope-like instrument (cystoscope) is inserted into the urethra and advanced to the bladder neck. This allows visualization of the bladder and urethra.
  • Incision: Using a cutting instrument (often an electrocautery loop or laser), the surgeon makes one or more small incisions at the bladder neck to relieve obstruction. The incisions widen the bladder neck and allow for smoother urine flow.
  • Completion: The procedure usually takes around 30 to 60 minutes. No sutures are needed, and a catheter may be placed temporarily to help drain urine after the procedure.
  • Postoperative care: Most patients are discharged the same day or within 24 hours. The catheter, if placed, is usually removed after a few days.

While BNI is generally safe, complications may include:
  • Urinary incontinence: Rare but possible, particularly if the external sphincter muscle is damaged.
  • Urinary tract infection (UTI): Due to instrumentation of the urinary tract.
  • Bleeding: Minor bleeding during or after the procedure.
  • Scarring: The bladder neck could scar again, leading to recurrent obstruction.
  • Erectile dysfunction: Though rare, it is a potential complication, especially in older men.
  • Retrograde ejaculation: Semen enters the bladder instead of exiting through the urethra during ejaculation.
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What are the benefits Bladder Neck Incision
  • Improved urine flow: Most patients experience significant relief from urinary symptoms, such as difficulty in urination, frequency, and incomplete emptying.
  • Minimally invasive: BNI is less invasive than open surgery and has a shorter recovery time.
  • Avoidance of more aggressive procedures: BNI is often preferred over transurethral resection of the prostate (TURP) or open prostatectomy for smaller prostates or specific bladder neck issues.
  • Short hospital stay: Many patients are treated on a day-case basis, reducing hospital time and overall costs.
Specialty: Who Performs Bladder Neck Incision?

The procedure is typically performed by:

  • Urologists: Trained specialists in urinary tract and male reproductive system diseases, urologists with specific experience in endourology perform BNI.
  • Specialized centers: Some large hospitals or specialized urology centers may focus on minimally invasive surgeries like BNI, offering the best outcomes with the latest technology.
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Infrastructure and Facilities

BNI requires the following specialized infrastructure and facilities:

  • Operating room equipped with advanced cystoscopic instruments, including: 1. Cystoscope (flexible or rigid)
    2. Electrocautery or laser equipment
    3. Monitors for visualizing the urinary tract
  • Anesthesia setup: Facilities for spinal or general anesthesia.
  • Sterile environment to minimize infection risk.
  • Post-operative recovery area: Patients should have access to observation and recovery facilities immediately after surgery.
  • Urology care unit: Hospitals with experienced urologists and nursing staff trained in urological care are ideal for this procedure.
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FAQs

Most patients can resume normal activities within a week, though strenuous activities should be avoided for 2-3 weeks.

A catheter is sometimes placed during the procedure to aid in healing and is typically removed after a few days.

BNI has a high success rate, especially in appropriately selected patients, with a significant improvement in urinary symptoms for most individuals.

BNI is not a cure for BPH, but it can relieve obstruction and urinary symptoms related to bladder neck narrowing or small prostates.

Retrograde ejaculation can occur but is more common after procedures like TURP. Your surgeon will discuss this risk before surgery.

Alternatives include medical management with alpha-blockers or 5-alpha reductase inhibitors, TURP, laser therapies, or open surgery in severe cases.

The procedure itself is painless due to anesthesia. Some discomfort or burning during urination may be felt in the first few days after surgery.

Bladder Neck Incision is a well-established, minimally invasive option for improving urinary flow, offering a shorter recovery time and fewer complications compared to more invasive surgeries.

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Copyright 2025 TRSCH - All Rights Reserve

Website Design and Development by Sterco Digitex

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