Bladder neck incision (BNI)

What is involved in the bladder neck incision (BNI) procedure?

Your prostate gland surrounds your urethra as it exits the bladder. When it enlarges (BPH), it can obstruct the urine flow. Bladder neck incision involves cutting through the neck of your bladder to allow you to pass urine more easily and with a better stream. A/Prof Homi Zargar performs this procedure at Melbourne's western suburbs (Western private hospital) and at Epworth, Richmond.
A/Prof Homi Zargar will assess whether the size and shape of your prostate make you a suitable candidate for this procedure. However, it may not be suitable for all men with prostate enlargement. The images below illustrate the opening of urethra after the procedure.

After treatment urinary flow improves significantly

One drawback of this approach is that may affect the mechanism of ejaculation in 10-50% of men


BNI main points

Key Points:

Bladder Neck Incision (BNI)

  • BNI involves creating a cut in the bladder neck using an energy source (electric or laser) passed through a telescope along the urethra.

  • After the procedure, a temporary catheter will be placed in the bladder for temporary urine drainage.

  • BNI is highly effective in addressing symptoms related to bladder outflow obstruction.

  • Approximately 4 out of 10 men may experience retrograde ejaculation afterward, leading to "dry" orgasms.

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anesthetist will meet with you to explore the options of a general or spinal anesthetic and discuss post-procedure pain relief.

Details of the procedure:

  • Depending on individual circumstances, the procedure is typically conducted under either general or local anesthesia.

  • Before the procedure, antibiotics are administered after confirming the absence of allergies.

  • A telescope is inserted into your bladder through the urethra.

  • To examine the bladder for additional issues, a telescope is inserted through the urethra (the water pipe).

  • The thickened muscle at the neck of the bladder is cut through using an energy source (electric or laser) as depicted.

  • In some cases, it may be deemed necessary to remove a portion of prostate tissue to ensure the continued clarity and openness of the urinary channel.

  • At the conclusion of the procedure, a catheter is placed into the bladder.

  • Bladder irrigation is typically employed through the catheter to flush out any clots or bleeding.

  • The entire procedure takes approximately 20 to 30 minutes on average.

  • After the procedure, a hospital stay of one to two nights can be anticipated.

  • The bladder catheter is usually removed after one night. Initially, passing urine may be painful and more frequent than normal. Tablets or injections can assist, and improvement is typically observed within a few days.

  • After the removal of the catheter, your urine may be bloody for 24 to 48 hours, and some patients may experience difficulty passing urine at this stage. If this occurs, another catheter is inserted before being removed again 48 hours later.

After-Effects and Risks of the Procedure:

  • Some of these effects are self-limiting or reversible, while others are not.

  • Rare after-effects (occurring in less than 1 in 250 patients) have not been individually listed.

    The impact of these after-effects can vary significantly from patient to patient.

    • Temporary mild burning, bleeding, and frequent urination

      • Occurs in almost all patients

    • Urinary tract infection requiring treatment with antibiotics

      • Risk: Between 1 in 2 & 1 in 10 patients

    • No semen is produced due to retrograde ejaculation (passes back into the bladder on ejaculation)

      • Risk: Between 1 in 2 & 1 in 10 patients

    • Failure to relieve symptoms completely

      • Risk: Between 1 in 50 and 1 in 100 patients

    • Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack, and death)

      • Risk: Between 1 in 50 & 1 in 250 patients (individual risk estimation by your anaesthetist)

    • Injury to the urethra causing delayed scar formation

      • Risk: Between 1 in 100 & 1 in 250 patients