Bladder Neck Incision (BNI)

• Men suffering with urinary symptoms associated with a tight bladder neck or stenosis
• Men with smaller, benign prostate glands that are causing bladder obstruction.

Durable improvement in urinary symptoms

• Avoid the need for life-long medications to treat the condition
• Fast recovery and minimal downtime after surgery

Bladder neck incision is performed under general anaesthesia.

• The procedure typically takes less than an hour
• There are no skin incisions involved
• Involves the use of a small camera (cystoscope), which is passed through the urethra and up to the bladder
• Electrocautery is used to incise the bladder neck and prostate on one or two sides, opening up the bladder neck, relieving pressure and improving flow of urine
• Patients can expect to stay in hospital with a catheter in place for 1-2 nights.

• The recovery is done at home and in most cases normal, light activities can be resumed within 3-5 days post procedure
• Complete recovery can take up to 4 weeks, during which time any strenuous activity should be avoided
• The most common side effects with BNI include discomfort or burning with urination, blood in the urine, an urgent need to urinate and/or difficulty controlling the urge. Most of these symptoms generally subside within the first 2 weeks following the procedure.

• Most patients will notice an immediate improvement in their urinary flow, pressure and bladder emptying
• Bladder symptoms or urinary frequency, urgency and nocturia tend to take longer to improve (up to 3 months)
• In a small number of patients, scarring can recur at the site of the operation as the tissues heal. It is possible that a new scar tissue may form in some patients, despite adequate incision of the bladder neck during surgery. If this occurs, it may require a further procedure to repeat the process
• Bladder neck incision may affect ejaculation function (if you are concerned about this, speak with your urologist prior to your surgery).

What to expect:
• You may have a catheter in place. Your doctor will advise you on the removal.
• Improved urinary flow, pressure, and bladder emptying.
• Blood in the urine is common for 2-4 weeks following your procedure, but in some cases it may take
longer to resolve. This may be intermittent.
• Urination frequency and urgency (urinating often and in a hurry) as well as nocturia (waking at night to
urinate) take longer to improve, and in most patients will settle within 3 months. In some circumstances
symptoms may persist. Some patients may benefit from bladder retraining with a pelvic floor
physiotherapist.
• Burning and stinging with urination may last days or up to weeks following the procedure. This does not
usually indicate infection, but is part of the healing process. You may use Ural (available over the counter
at pharmacies) to alleviate your symptoms.

Return to activity:
• Driving – no driving for 2 weeks following surgery
• Work – you will require some time off work. The duration depends on your occupation
• Lifting – avoid heavy lifting or straining to open bowels for at least 4 weeks after surgery, to minimize the
risk of secondary bleeding
• Activities – walking is fine and encouraged after surgery. Strenuous activity including running, gym, golf,
cycling and swimming should be avoided for 4 weeks.
• Sex – avoid for 4 weeks.

Pain Management:
You may take ibuprofen or paracetamol if you are experiencing pain or discomfort. Ural sachets (available over
the counter at pharmacies) can help with burning or stinging with urination.

Head to your nearest hospital emergency room if you have:
• You unable to urinate (this may be due to secondary bleeding and clots; this can occur within the first
month or so after surgery)
• Fevers, chills or shakes (may indicate infection).

Follow-Up Information:
Our rooms will contact you to arrange a follow-up appointment with your urologist, typically 6-8 weeks following
surgery
Your follow-up appointment is on: ____________________ at __________________.

Contact Information:
If you have any questions or concerns that are not addressed here or in the procedure information available on
our website melbourneurologycentre.com.au contact our rooms on 1300 702 811 or [email protected]

ost-Operative information for this procedure can be found here: BNI Post-Operative Care Instructions

Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa

References

Brede, C., Angermeier, K., Wood, H., (2014), Continence Outcomes After Treatment of Recalcitrant Postprostatectomy Bladder Neck Contracture and Review of the Literature, [https://www.sciencedirect.com/science/article/abs/pii/S0090429513013940] accessed 30/05/2022.

D’Ancona, C. A., Netto, N. R., Cara, A. M., Ikari, O., (199), Internal Urethrotomy of the Prostatic Urethra or Transurethral Resection in Benign Prostatic Hyperplasia, [https://www.sciencedirect.com/science/article/abs/pii/S0022534717396222] accessed 30/05/2022.