Bladder Neck Incision (BNI)

Bladder neck incision is an operation where an incision is made in the neck of the bladder to improve the flow of urine.

The aim of surgery is

  • To remove the obstruction
  • To improve the flow of urine
  • To prevent complications such as retention, urinary tract infections, bladder stones and damage to the kidneys
  • It is sometimes needed to relieve scarring after a prostate procedure

Symptoms prior to surgery include

  • Poor stream or flow
  • Slowness in starting to void
  • Dribbling following a void
  • Nocturia – getting up at night to pass urine
  • Urgency – the need to pass urine urgently and consequently leakage can occur
  • Urine leakage when coughing or sneezing
  • No urine flow (retention)

Information on the surgery

You will be admitted on the day of surgery and be expected to remain in hospital for 1-2 days. The surgery is carried out either under general anaesthetic or spinal anaesthetic. There will be no incisions instead a telescope is inserted through the urethra and into the bladder where the blockage is visualized. The surgeon will then remove the obstruction and an indwelling urethral catheter will be inserted into the bladder to flush the bladder and help settle any bleeding.

Medications

Please discuss with your surgeon if you are on aspirin, warfarin or other blood thinning substances (iscover, plavix).

Before surgery

  • You will be advised when to stop taking blood thinning medications by your surgeon.
  • If you are a diabetic on insulin, please discuss this further with the Practice Nurse
  • Tests required: Urine culture and bloods (FBE, U&E’s).
  • Ensure your bowels are well opened the day before and on the day of surgery. You may be required to take aperients to help with this. Please discuss this further with the Practice Nurse.

Following surgery

  • The catheter will remain in place for 12-24 hours post-surgery and a bladder irrigation will be in place to continually flush the bladder.
  • Your urine will be rose in colour and you may pass clots. This is expected following surgery.
  • The catheter and irrigation will be removed only when the blood in the urine has cleared up.
  • You will have an intravenous drip and this will be removed 1-2 days following surgery or as advised by your surgeon.
  • You must maintain your fluid intake to 2-3 litres per day or as advised by your surgeon if you have other medical issues.
  • You will have adequate pain relief following the procedure. If the pain relief is not effective, please discuss this further with the ward nursing staff.
  • Once the catheter is removed and you are passing urine with no problems, you will be allowed to go home.

Following discharge

  • You may experience burning, frequency and urgency which will subside in a few weeks.
  • Your urine may be blood stained and have small clots for 3-4 weeks following discharge. This is expected. Please monitor your urine flow and ensure you have not developed urinary retention.
  • You are advised to maintain high fluid intake to help flush out the bladder.
  • Avoid constipation as any straining may cause further bleeding. Please discuss this with your Practice Nurse if you have concerns. Some bleeding may occur after a bowel action. Drinking adequate fluids and resting following a bowel action will help settle down the bleeding.
  • Avoid caffeine containing drinks and alcohol as these can irritate the bladder and cause further frequency.
  • Avoid heavy lifting, straining, no bowls, no lawn mowing, golf or tennis. Gentle exercise such as walking is allowed.
  • You are able to drive 2 weeks following surgery or as advised by your surgeon.
  • You may return to work 2 weeks following surgery if you are in an office, otherwise, if you engage in manual work then 3-4 weeks following surgery.
  • You may return to sexual activity 4 weeks following surgery.

Please contact the practice if experiencing any of the following

  • Urinary frequency, burning and urgency lasting more than 8 weeks.
  • Signs of a urinary tract infection – offensive and/or cloudy urine, sediment, fever, chills, rigors, nausea.
  • Not able to pass urine
  • Excessive and continual bleeding.

Points to note

  • You may develop retrograde ejaculation following the procedure (ejaculation goes into the bladder).
  • Discuss with your surgeon when you can recommence your blood thinning medication.
  • You will return for your review appointment with your surgeon 4 weeks following your procedure.