One infrequent but troublesome complication of radical
prostatectomy is bladder neck contracture. This happens when dense scar
tissue forms in the bladder neck, the area where the bladder and urethra
are joined together after the prostate is removed. The thickened scar
tissue narrows the inside of the urethra, causing a slow-down —
or sometimes even an outright blockage — of urine flow. Exactly
why this scar tissue forms is unknown, but it may be due to poor healing
at the surgical site.
Mild cases are fairly simple to treat; a urologist dilates the area,
using instruments passed through the urethra. Or, if the contracture is
more significant, the urologist uses a cystoscope, passed through the
penis, to make cuts in the scar tissue and break its stranglehold on the
urethra. Rarely, however, severe contracture can cause the urethra to
become completely obstructed.
“In the past, the only option when the opening was completely blocked
was major surgery,” says Thomas W. Jarrett, M.D., associate professor
of urology, and chief of the Division of Endourology and Laparoscopy.
This was especially tough on men who had just undergone major surgery,
radical prostatectomy. Recovering from this procedure could take months,
and involved the long-term use of a catheter (placed either in the urethra
or directly into the bladder, through the skin in the lower abdomen).Worse,
men faced a high risk of impotence and long-term incontinence from the
extra surgical trauma.
Jarrett has developed a new technique that avoids a second open surgical
procedure, and all of the complications that go with it. “In this
technique, we place small telescopes simultaneously through the penis
and through a tiny incision above the pubic bone,” Jarrett explains.
“We have been able to successfully reestablish the channel between
the bladder and urethra in a minimally invasive fashion in all patients.”
Once the urethra is reopened, Jarrett cuts the scar tissue, using a laser
beam to minimize trauma to the tissues. Then, very gently and gradually,
over the next few months, he enlarges the urinary tract until it is stable.The
theme of this approach, borrowing from Aesop, is “Slow and steady
wins the race.” The process may require several minor surgical revisions
to treat additional scar tissue. Also, during this time of healing, “the
patient must catheterize himself on a regular basis to prevent the opening
However, the results are worth the wait, Jarrett concludes: “Using
this technique, we have been able to successfully treat most patients
without major surgery and the devastating side effects of impotence and