bladder neck incision or tuip experience

[virginiadiaper]

So has anyone had a bladder neck incision also known as a TUIP? What was the recovery like? Was it a success? Did the urine symptoms get worse before it got better? Was the incontinence cured after the procedure or persist? Hopefully some can give some insight into some personal experiences with this procedure.

 

[winterheart01]

So has anyone had a bladder neck incision also known as a TUIP? What was the recovery like? Was it a success? Did the urine symptoms get worse before it got better? Was the incontinence cured after the procedure or persist? Hopefully some can give some insight into some personal experiences with this procedure.

I had both incision in urethral sphincter and bladder neck, the bladder neck incision was a failure due to massive recurring scar tissue.
After several Turp (prostate and bladder neck combined) i still had retention issues and the first hospital offered a catheterizable urostomy through the belly button which would require a part of the intestines to create an alternate tunnel to the bladder neck.
However other doctors said with my diabetes the risk of complications were too high.
So i went to another hospital and they were willing to remove portions of both sphincters, but while the surgery was a success, scar Tissue came back.
So after the third surgery they removed everything of the urethral sphincter and bladder neck , i can feel some scar tissue returned but it's not enough to block the flow.
It was needed because I had chronic infected tissue on the bladder neck.

The recovery was long and painful but better than what I was told from the urostomy.
I couldn't do any garden work for 3 months without having pain afterwards.
The bladder neck is very sensitive so any surgery will hurt quite a bit there.

 

[virginiadiaper]

That sounds rough for sure. Did they use a laser as I think that typically causes less scar tissue?

 

[winterheart01]

That sounds rough for sure. Did they use a laser as I think that typically causes less scar tissue?

They used cold knife and hot knife technique
Maybe the last time they used laser i don't know but i barely bled the last time so there's a good chance .
But in the end I'm so happy I'm rid of my retention and it flows freely, i can live a normal life with some adjustments such as diaper changes every 5h but that's better than pushing a catheter in my belly button
Just one warning: after a surgery at the bladder neck, drink water like crazy for the first 2 weeks to flush bacteria out , if it gets infected, scar tissue comes up and causes more bacteria to accumulate and causes a chronic infection + over time antibiotics resistant bacteria.
Which is my case, hence the drastic measures.
The urostomy would not have solved this problem so the choice was simple.

 

[virginiadiaper]

That sounds like a long road and glad you are better. Are you now fully incontinent and diaper dependent as a result of all this surgery? Hopefully some others will respond with a less complicated road to recovery.

 

[winterheart01]

That sounds like a long road and glad you are better. Are you now fully incontinent and diaper dependent as a result of all this surgery? Hopefully some others will respond with a less complicated road to recovery.

I am yes, however because my pelvis is very strong i don't leak while sleeping unless the bladder is quite full.
I am prescribed diazepam for this but it helps only partially.
Other than that I'm fine now. It was worth the pain to get an acceptable life back.

 

[virginiadiaper]

I’m glad you have an acceptable life back. Are there any others with a more routine recovery from TUIP or a bladder neck incision?

 

[virginiadiaper]

I had a bladder neck incision in 2017 and havent been dry since.

What happened? It’s not supposed to make you incontinent as the one sphincter still works.

 

[winterheart01]

What happened? It’s not supposed to make you incontinent as the one sphincter still works.

Depending on the underlying condition, a hole in the bladder neck can cause increased urges and minor leaks.
For me it led to increased urges for many years after they did the first TURP (which was combined with a bladder neck incision)
I did dribble more than before but back then had no incontinence. So all I can say is, there must be an underlying condition, maybe nerve related, to cause the urethral sphincter to ignore the pressure and open up.
Heavy sleepers are usually susceptible to bedwetting in such cases.

 

[virginiadiaper]

It isnt straightforward. I had a turp first, then got sepsis and then scar tissue. This led to a urethraotomy and then the bladder neck incision. Urodynamics shows that the nerves dont work properly anymore.

I have heard TURPs commonly cause problems, but I am wondering what it’s like to just have a bladder neck incision to relieve a blockage.

 

[winterheart01]

I have heard TURPs commonly cause problems, but I am wondering what it’s like to just have a bladder neck incision to relieve a blockage.

well, after everything is healed, you'd have to pay more attention hen an urge strikes, daytime accidents would happen if you're not paying attention and consciously holding it, but a bladder neck incision alone will normally not cause daytime incontinence except for some post urination dribbling perhaps.
The urethral sphincter will have to be the one serving as last barrier, so he'll have to carry a heavier burden.

My biggest concern is infections, hence i mentioned drinking lots of water post surgery.
that region is prone for chronic infections, scar tissue (also referred to as bladder neck sclerosis) , which I all had btw.
From my and my urologists experience, cutting nerves will grow back as a scar and a new nerve will grow elsewhere or simply repeat your problem.
Cutting a narrow v shape will grow back together and cutting our a wide V or half crescent moon shape will give best results if you don't get much scar tissue.

 

[virginiadiaper]

well, after everything is healed, you'd have to pay more attention hen an urge strikes, daytime accidents would happen if you're not paying attention and consciously holding it, but a bladder neck incision alone will normally not cause daytime incontinence except for some post urination dribbling perhaps.
The urethral sphincter will have to be the one serving as last barrier, so he'll have to carry a heavier burden.

My biggest concern is infections, hence i mentioned drinking lots of water post surgery.
that region is prone for chronic infections, scar tissue (also referred to as bladder neck sclerosis) , which I all had btw.
From my and my urologists experience, cutting nerves will grow back as a scar and a new nerve will grow elsewhere or simply repeat your problem.
Cutting a narrow v shape will grow back together and cutting our a wide V or half crescent moon shape will give best results if you don't get much scar tissue.

I can’t imagine there won’t be more urges and need for continued 24/7 diapers for a while. Hopefully getting rid of the blockage will help regain some control. At least it’ll help protect the kidneys to be able to drain the bladder more. Hopefully it won’t scar back or that will suck.

 

[winterheart01]

I can’t imagine there won’t be more urges and need for continued 24/7 diapers for a while. Hopefully getting rid of the blockage will help regain some control. At least it’ll help protect the kidneys to be able to drain the bladder more. Hopefully it won’t scar back or that will suck.

The first few days you really should wear a pad, because after they remove the catheter you will dribble and may have small accidents, but they go away. And yes you can make it to the toilet for the rest of the urine.
But you'll lose blood, this you cannot hold back
I recommend buying one pack of thin anatomical shaped incontinence pads you can place in your underwear and are just good enough for one medium to full voiding should you get surprised.
But anything thicker is not required for this surgery.
Also after a week when things are slowly healing, you'll find you need them less, just keep wearing them until the bleeding stops and keep some aside, after a few weeks, the crusts start to come loose, this hurts and blood loss will occur again (depending on the size of the incision).
At first you'll have more frequent urges because the urine irritates the wound, after that it simply reaches the urethral sphincter faster because the bladder neck won't hold everything back anymore, but that should be a slight urge.
Only when you sit and then get up after z few hours you may get a more stronger urge because the whole weight is pushing on the urethral sphincter.
Listen to your body and go when you feel the need to, don't go too often but don't wait too long either and you should be fine.
After going on the toilet, its good idea to lift your pelvis a bit forward as if you're emptying a cup of coffee, to remove the last residue. (Physiotherapist taught me that).

 

[virginiadiaper]

The first few days you really should wear a pad, because after they remove the catheter you will dribble and may have small accidents, but they go away. And yes you can make it to the toilet for the rest of the urine.
But you'll lose blood, this you cannot hold back
I recommend buying one pack of thin anatomical shaped incontinence pads you can place in your underwear and are just good enough for one medium to full voiding should you get surprised.
But anything thicker is not required for this surgery.
Also after a week when things are slowly healing, you'll find you need them less, just keep wearing them until the bleeding stops and keep some aside, after a few weeks, the crusts start to come loose, this hurts and blood loss will occur again (depending on the size of the incision).
At first you'll have more frequent urges because the urine irritates the wound, after that it simply reaches the urethral sphincter faster because the bladder neck won't hold everything back anymore, but that should be a slight urge.
Only when you sit and then get up after z few hours you may get a more stronger urge because the whole weight is pushing on the urethral sphincter.
Listen to your body and go when you feel the need to, don't go too often but don't wait too long either and you should be fine.
After going on the toilet, its good idea to lift your pelvis a bit forward as if you're emptying a cup of coffee, to remove the last residue. (Physiotherapist taught me that).

That’s all great advice. I’m already in diapers at night and pull-ups or diapers during the day so beyond pads already. I suppose it’ll get a little worse then improve after a week or so based upon what you are saying. I don’t have high hopes for the night time bed wetting to improve, but hoping the very 30-45 minute frequency gets better and some less protection is needed over time.

 

[virginiadiaper]

So brief update, they cut out a good portion of my internal sphincter and bladder neck. Doing two incisions did not open the area at all apparently. I had a big improvement in the stream postop but now it is back to somewhat better than preop. The frequency and urgency is still there. I’m onto bladder spasm med #2 to see if it calms down the frequency. I’m incompletely emptying still, but not enough to cath myself. So I can’t say the surgery did too much other than the emptying didn’t get worse and the stream got a little better. With going to urinate every 30-45 minutes, I’m still in diapers 24/7 and wetting every night. I am wondering if the surgical area closed back up some with scar tissue but not fully scarred up. I imagine a TURP or HOLeP is in my future to open it completely so that I do not get problems from incomplete emptying. Hopefully we can put that off a few years if at all possible. I imagine they will want to do something more if I am retaining more urine over time.

 

[slimjiminy]

I had a procedure done in December where they cut away some tissue at the outer sphincter is because I was having a limited stream (they could not get the camera into the bladder). I had this performed once before in the early 90's too. But the same thing has happened. Months later, the tissue has healed up and the flow has gone from "race horse" to "limited", though it is still better than I had last year. This last time that I had the procedure, I was awake for the whole thing and the cutting was painful -- not something I am anxious to repeat.

 

[winterheart01]

So brief update, they cut out a good portion of my internal sphincter and bladder neck. Doing two incisions did not open the area at all apparently. I had a big improvement in the stream postop but now it is back to somewhat better than preop. The frequency and urgency is still there. I’m onto bladder spasm med #2 to see if it calms down the frequency. I’m incompletely emptying still, but not enough to cath myself. So I can’t say the surgery did too much other than the emptying didn’t get worse and the stream got a little better. With going to urinate every 30-45 minutes, I’m still in diapers 24/7 and wetting every night. I am wondering if the surgical area closed back up some with scar tissue but not fully scarred up. I imagine a TURP or HOLeP is in my future to open it completely so that I do not get problems from incomplete emptying. Hopefully we can put that off a few years if at all possible. I imagine they will want to do something more if I am retaining more urine over time.

I had this done 3 times.
First a small wedge, grew back together 50%.
Then bigger wedge, was better but scar tissue still formed a blockade.
Third time they removed the entire urethral sphincter, as much from the bladder neck as possible due to chronic infection and they removed barrier ridges between those 2 sides and the prostate.
I'm now constantly leaking, impotent but bacteria and infection free.
No more issues of OAB or detrusor sphincter dyssinergia.