Bladder Neck Incision (BNI)

Bladder Neck Incision (BNI), also known as Bladder Neck Relaxation, is a surgical procedure used primarily to treat bladder outlet obstruction (BOO), commonly resulting from an enlarged prostate or bladder neck contracture. This procedure is aimed at improving urine flow and alleviating symptoms associated with urinary retention.

Procedure Overview

Technique: The procedure involves making precise cuts at the bladder neck and the region where the prostate meets the bladder (the prostatic urethra). These cuts help to widen the urinary passage and reduce resistance to the flow of urine.
Instrumentation: BNI is typically performed using an endoscope—a thin, flexible tube with a camera and light. The surgeon inserts the endoscope through the urethra to reach the bladder neck. Surgical tools used through the endoscope allow the surgeon to make incisions without external cuts.
Anesthesia: The procedure is usually conducted under general or spinal anesthesia.

Indications

BNI is indicated for:

Benign Prostatic Hyperplasia (BPH): Particularly when the enlargement primarily affects the bladder neck.
Bladder Neck Contracture: Scar tissue that narrows the bladder outlet, often a complication of prostate surgery.
Neurogenic Bladder Disorders: In some cases, where the bladder neck is inappropriately contracted.

Risks and Complications

Like all surgical procedures, BNI carries potential risks and complications, including:

Bleeding: Some blood in the urine is expected immediately after the surgery.
Infection: Risk of urinary tract infections or, in rare cases, sepsis.
Urinary Incontinence: There is a risk of temporary or, rarely, permanent urinary incontinence due to damage to the sphincter muscles.
Retrograde Ejaculation: This occurs when semen enters the bladder instead of exiting through the urethra during ejaculation. It is a common side effect but does not affect orgasmic pleasure.
Need for Reoperation: In cases of recurrent bladder neck contracture or insufficient initial relief, additional surgery may be necessary.

Postoperative Care

Catheterization: Patients generally require a catheter for a few days to allow healing and ensure the bladder remains empty.
Activity Restrictions: Patients are advised to avoid strenuous activities and heavy lifting for several weeks to prevent complications.
Follow-Up: Regular monitoring is necessary to assess the effectiveness of the procedure and to manage any complications.

Recovery and Outcome

Most patients experience significant improvement in their symptoms following BNI. The recovery period can vary, but many patients can resume normal activities within a few weeks. The long-term success of the procedure depends on the underlying condition and the patient's overall health.

BNI is a valuable treatment option for specific cases of urinary obstruction. It is less invasive than some alternative procedures, such as prostatectomy, and typically has a quicker recovery time. Patients considering BNI should discuss with their urologist the potential benefits and risks, as well as how this treatment fits into their overall health management plan.