The bladder neck is a group of muscles that connect the bladder to the urethra. The muscles tighten to hold urine in the bladder, and relax to release it through the urethra. Urinary problems occur when abnormalities block the bladder neck and prevent it from opening completely during urination.
Men over age 50 are more likely to develop bladder neck obstruction than any other group. However, the condition can occur in both men and women at any age.
The bladder can become permanently weakened if treatment for bladder neck obstruction is delayed for an extended period of time. A weakened bladder may lead to complications such as:
- urinary tract infections
- kidney damage
- bladder diverticula, which are bulging pouches that can form in the bladder
- long-term incontinence, which is a lack of bladder control
Call your doctor if you believe you have bladder neck obstruction. Prompt treatment will relieve your symptoms and prevent complications from developing.
Men and women who have bladder neck obstruction experience similar symptoms, which often include the following:
- an irregular output of urine
- incomplete bladder emptying
- increased urinary frequency
- increased urinary urgency
- an inability to control the urge to urinate
- pelvic pain, which is more common in men than in women
An enlarged prostate is often responsible for causing bladder neck obstruction. The prostate is a small gland in the male reproductive system. It surrounds the urethra and produces most of the fluid in semen.
When the prostate gland becomes swollen, it squeezes the urethra and restricts the flow of urine. The obstruction can become so severe that no urine will be able to leave the bladder at all.
Bladder neck obstruction may also be a side effect of surgery to remove the prostate or of radiation treatments used to treat prostate cancer. Scar tissue from these procedures can block the bladder neck.
Although bladder neck obstruction is rare in women, it can develop when the bladder drops into the vagina. This usually occurs as a result of a weakened vaginal wall. The vaginal wall may become weak due to:
- advanced age
- menopause
- a difficult delivery
- multiple births
In some cases, bladder neck obstruction might even be caused by a genetic flaw in the bladder structure or its surrounding muscles and connective tissues.
The symptoms of bladder neck obstruction are similar to those of several other conditions, including urinary tract infections and neurogenic bladder.
Video urodynamics
To make the correct diagnosis, your doctor will likely use video urodynamics. This is a series of tests that are performed to evaluate bladder function.
During video urodynamics, X-rays or an ultrasound will be used to take detailed images of your bladder in real time. A thin tube called a catheter will be inserted into your bladder to empty any urine inside. The catheter will then be used to fill your bladder with fluid.
Once the bladder is full, you may be asked to cough and then to urinate as much as possible.
The resulting images allow your doctor to observe bladder neck obstruction as the bladder fills and empties. Video urodynamics can also help them detect any structural problems in the bladder or urethra.
Cystoscopy
Cystoscopy may also be used to diagnose bladder neck obstruction. This involves the use of a device called a cystoscope to look inside the bladder. A cystoscope is a long, thin tube with a camera and light attached at the end.
During the procedure, your doctor will insert the cystoscope through the urethra and into the bladder. A liquid may be used to fill and stretch the bladder so your doctor can get a better view.
Bladder neck obstruction may be treated with medication or surgery. Your specific treatment plan will depend on your overall health and the cause of your condition.
Medications
Alpha-blocker drug therapy is usually the first step in treating bladder neck obstruction. Alpha-blockers, such as tamsulosin or alfuzosin, can help to relax the bladder muscles.
A second type of medication, 5-alpha-reductase inhibitors, may also be prescribed to treat bladder neck obstruction. These medicines, such as finasteride and dutasteride, work to reduce enlarged prostates.
Self-Catheterization
In some cases, self-catheterization will need to be used along with alpha-blocker medications. Self-catheterization is a safe, painless procedure that will help you empty your bladder of urine.
Catheterization may be temporary or ongoing. It often depends on the severity of your condition and on how well your symptoms are responding to medication. Your doctor can show you how to insert the catheter into your bladder and how to keep it clean.
Surgery
You may need surgery if your condition doesn’t improve with medication and self-catheterization. The standard surgical treatment for bladder neck obstruction is transurethral resection of the prostate (TURP).
During TURP, portions of the prostate are resected, or cut away. Any blocked ducts can also be removed. A surgeon will use a knife to remove the tissue, but it is a minimally invasive procedure, which makes healing and recovery easier.
Laser removal may be preferred over a TURP. Greenlight laser and holmium laser enucleation (HoLep) use different types of laser to remove or destroy any tissue on the prostate that is blocking urine flow.
These procedures may be preferred for some patients’ anatomy, and additionally they have several advantages over standard TURP, including less blood loss and a shorter recovery period.
A newer surgical option, UroLift is a procedure that inserts small clips in any blocked urinary pathways to hold them open. This procedure, which was approved in 2013, is also called a prostatic urethral lift (PUL).
In recent years, aquablation has also shown promising results as a newer therapy for bladder neck obstruction. In this procedure, high-pressure saline is used instead of a laser or knife to remove tissue from the prostate.
Bladder neck obstruction may exist for many years with few symptoms before treatment is sought. However, once it’s treated, the symptoms of bladder neck obstruction typically subside.