Bladder Neck Incision (BNI): What It Is and When It’s Needed
Urinary self-care can do wonders for a person’s comfort, confidence, and overall quality of life—especially when one’s flow of urine is interrupted by a blockage in the lower urinary tract. One such condition is bladder neck obstruction, which can lead to symptoms such as poor stream, hesitancy (difficulty starting urination), frequency (where patients need to go to the toilet often), and nocturia (waking a lot at night to urinate).
Bladder Neck Incision (BNI) is a type of keyhole (or minimally invasive) surgery that is used to remove this obstruction and help improve urination. Patients with BNI are generally men with a significant burden of symptoms and obstruction at the bladder neck, and BNI has been found to be a safe and effective treatment with a quick recovery. In this blog post, we delve into what BNI is, who it is best for, and what to expect before, during, and after the treatment.
What is a Bladder Neck Incision?
Bladder Neck Incision is a surgical intervention requiring general or spinal anaesthesia. It requires the use of a narrow endoscopic instrument that is inserted into the urethra (the tube that allows the passage of urine out of the body). With it, electrocautery or laser energy is used to make incisions at the bladder neck.
This is an area where the bladder joins the urethra, referred to as the bladder neck. In some men—particularly those with BPH or scarring following prostate surgery—this area can become narrowed, blocking the flow of urine.
By incising the internal sphincter and relieving the narrow passageway, the procedure relieves the blockage and contributes to the recovery of proper urinary function.
Who Needs a BNI?
BNI is often advised when other treatments through non-surgical options, such as drugs, have not relieved a patient’s pain satisfactorily. It’s particularly good for:
- Men who have blockage of the bladder from scarring or muscle tightness.
- Those who have had persistent LUTS, including voiding difficulty, retention, and chronic UTIs.
- Men who have already had prostate surgery and formed bladder neck contracture.
Your urologist will perform an extensive evaluation, including a physical examination, urine tests, and cystoscopy or flow rate measurement, prior to recommending surgery.
What to Expect During the Procedure
The process is typically performed with general or spinal anaesthesia and lasts about 30–60 minutes. Here’s a detailed breakdown of what generally occurs:
- Preparation – After you receive anaesthesia, your consultant will insert a sterile endoscopic instrument called a resectoscope into the urethra.
- Incision – A surgeon creates incisions in the neck of the bladder (narrow part of the urethra) with an electrocautery loop or a device that delivers holmium laser energy to expand the narrowed area.
- Irrigation and Observation – The bladder is irrigated with fluid to remove debris, and the area is closely inspected for bleeding or damage.
- Catheterisation – A Foley’s catheter is passed for temporary drainage of urine and to allow the area to heal. This is typically taken out in 24 to 48 hours.
BNI is an ambulant or short-stay surgery; that is, the majority of patients are able to go back home on the day of their surgery or after staying overnight in the hospital.
Recovery and Aftercare
Recovery from BNI is generally uneventful, and most patients show clinical improvement within several weeks. Crucial elements of the recovery process are:
- Catheter Care – You may be discharged home with a catheter for a day or two.
- Some discomfort – It’s OK to have a little burning when you pee, see some tiny flecks of blood, and have to pee more often for a few days after.
- Recovery time – You may be able to get back to mild activities after a few days, but avoid heavy lifting or intense exercise for 2–3 weeks.
- Follow-up – Your doctor will schedule a follow-up visit to make sure you are healing and that the procedure was a success.
Risks and Considerations
As with all surgery, there are potential risks from BNI. These may include:
- Bleeding or infection (uncommon with correct aftercare).
- Retrograde ejaculation, when the semen goes into the bladder instead of coming out through the urethra (a common but harmless side effect).
- Formation of scar tissue—in some cases, the narrowing may recur, necessitating additional treatment.
An open conversation about your health history and desires with a urologist is key to understanding whether BNI is the correct method for your needs.
Conclusion: Restoring Comfort and Confidence
Bladder Neck Incision is a safe and effective minimally invasive treatment option for the relief of urinary obstruction due to bladder neck narrowing. It provides durable relief and a remarkable enhancement in the quality of life for many men.
If you have urinary symptoms that are impacting your day-to-day life, don’t put them on the back burner—there is help, and you don’t have to live in discomfort. The earlier you have them checked and a personalised plan is tailored just for you, the fewer complications.
For an in-depth analysis of this treatment, make an appointment to see one of our friendly, highly trained urology professionals in store.
To learn more, please click on the NHS resource: Holmium Laser Bladder Neck Incision
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