The bladder neck is a critical structure located at the base of the bladder, where it connects to the urethra. Anatomically, it plays a vital role in maintaining urinary continence and facilitating the controlled release of urine from the bladder. Several diseases and conditions can affect the bladder neck, leading to urinary problems.

What is the bladder neck?

The bladder neck is a crucial anatomical structure located at the base of the urinary bladder, where it connects to the urethra. It acts as a functional valve or sphincter that helps control the flow of urine from the bladder into the urethra. The bladder neck is composed of smooth muscle fibers and is surrounded by connective tissue, allowing it to perform its role in urinary continence effectively.

Is bladder neck different in men and women?

Yes, the bladder neck differs between men and women in several ways:

• Anatomical Location:
  • Men: The bladder neck is situated just below the prostate gland, and it is surrounded by prostate tissue. The prostate contributes to the sphincter mechanism that controls urine flow.
  • Women: The bladder neck is located above the vaginal opening and is not influenced by prostate tissue. It is surrounded by the muscles of the pelvic floor and the external urethral sphincter.
• Sphincter Mechanism:
  • Men: The bladder neck’s sphincter function is partly provided by the prostate and the internal sphincter muscle. This complex mechanism helps in urinary control and ejaculation.
  • Women: The sphincter function is mainly provided by the external urethral sphincter and the pelvic floor muscles, as there is no prostate gland. The pelvic support structures play a significant role in maintaining continence.
• Size and Shape:
  • Men: The bladder neck is generally larger and more complex due to the surrounding prostate. This can lead to different types of obstructions, such as benign prostatic hyperplasia (BPH).
  • Women: The bladder neck is smaller and less complex. Problems in women are often related to pelvic floor dysfunction or scarring rather than prostate enlargement.
• Common Disorders:
  • Men: Bladder neck obstruction due to prostate enlargement (BPH) is a common issue. Prostate cancer and related treatments can also impact the bladder neck.
  • Women: Conditions like bladder neck contracture, pelvic organ prolapse, and post-surgical changes (e.g., after hysterectomy) are more common.
• Symptoms and Management:
  • Men: Symptoms such as difficulty starting urination, weak stream, and frequent nighttime urination are often related to prostate issues.
  • Women: Symptoms may include urinary urgency, frequency, and incontinence, often linked to pelvic floor weakness or other structural issues.

Functions of the bladder neck

Main functions of the bladder neck are:

• Urinary Continence: The bladder neck helps maintain urinary continence by keeping the bladder closed when it is not time to urinate. It works in coordination with the external urethral sphincter to prevent involuntary leakage of urine.
• Urine Flow Regulation: During urination, the bladder neck relaxes and opens to allow the passage of urine from the bladder into the urethra. This process is facilitated by the contraction of the detrusor muscle, which pushes urine out of the bladder.
• Pressure Maintenance: The bladder neck helps maintain the appropriate pressure within the bladder to store urine efficiently until it is time for voiding.

Common disease and problems of bladder neck

Common diseases and problems of the bladder neck in in men and women is as follows:

Men:

• Benign Prostatic Hyperplasia (BPH)
  • Prostate Cancer
  • Bladder Neck Obstruction
  • Bladder Neck Stricture
  • Bldder neck elevation (high insertion)
  • Neurogenic Bladder Dysfunction
  • Post-Surgical Changes

Women:

• Bladder Neck Contracture
  • Pelvic Organ Prolapse
  • Neurogenic Bladder Dysfunction
  • Post-Surgical Changes (e.g., after hysterectomy)

Symptoms of bladder neck problems

Symptoms of bladder neck problems can vary depending on the specific condition but commonly include:

• Difficulty urinating
• Weak urine stream
• Frequent urination
• Incomplete bladder emptying
• Urinary retention
• Pain or discomfort
• Urgency with ıncontinence
• Blood in urine

Diagnosis of bladder neck problems

Diagnosing bladder neck problems typically involves a combination of medical history, physical examination, and diagnostic tests. Here’s an overview of the common methods used:

• Medical History and Symptom Review: The doctor will ask about the patient’s symptoms, urinary habits, and any relevant medical history. This helps in understanding the nature of the problem and ruling out other conditions.
• Physical Examination: A physical examination, including a pelvic examination in women and a digital rectal examination (DRE) in men, may be conducted to check for abnormalities and assess the prostate (in men) or other structures that might affect the bladder neck.
• Urinalysis: A urine sample is tested for signs of infection, blood, or other abnormalities that might indicate bladder neck issues or other urinary tract problems.
• Post-Void Residual Measurement: This test measures the amount of urine left in the bladder after urination. High residual volumes can suggest bladder neck obstruction or dysfunction.
• Urodynamic Studies: These tests evaluate how well the bladder and urethra are functioning. They include: Cystometry, urethral pressure profilometry (upp) and uroflowmetry.
• Cystoscopy: This allows the doctor to visually inspect the bladder neck and diagnose any abnormalities or obstructions.
• Imaging Studies: Ultrasound, CT Scan or MRI: May be used to get detailed images of the urinary tract if more complex issues are suspected.
• Bladder Neck Biopsy: In some cases, if a growth or abnormal tissue is found, a biopsy may be performed to determine if it is benign or malignant.

Treatment of bladder neck problems

Treatment for bladder neck problems depends on the specific condition and its severity. Here are common approaches for managing bladder neck issues:

• Medications:
  • Alpha-blockers: Used to relax the muscles of the bladder neck and prostate (in men), improving urine flow and reducing symptoms of obstruction.
  • 5-alpha-reductase inhibitors: Help shrink the prostate (in men) if an enlarged prostate is causing bladder neck obstruction.
  • Anticholinergics or Beta-3 agonists: May be used to manage symptoms of bladder overactivity or urgency.
• Behavioral Therapies:
  • Bladder Training: Involves scheduled voiding and techniques to increase the bladder’s capacity and control.
  • Pelvic Floor Exercises: Strengthening the pelvic floor muscles can help improve urinary control.
• Minimally Invasive Procedures:
  • Transurethral Resection of the Prostate (TURP): A common procedure for men with bladder neck obstruction due to an enlarged prostate. It involves removing part of the prostate to relieve pressure on the bladder neck.
  • Balloon Dilation: A procedure where a balloon is inserted and inflated at the bladder neck to widen the area if it is narrowed.
• Surgical Interventions:
  • Bladder Neck Incision (TUIP): A surgical procedure to make a small incision in the bladder neck to relieve obstruction.
  • Bladder Neck Reconstruction: In cases of severe scarring or deformity, surgery may be performed to reconstruct the bladder neck and restore normal function.
• Management of Underlying Conditions:
  • Treating any underlying conditions such as prostate cancer, neurogenic bladder, or urethral strictures can help resolve bladder neck issues.
• Catheterization:
  • For patients who cannot urinate effectively due to bladder neck problems, intermittent or indwelling catheters may be used to help manage urinary retention and prevent complications.
• Lifestyle and Dietary Changes:
  • Adjustments in fluid intake, diet, and avoiding irritants such as caffeine or alcohol may help manage symptoms and improve overall bladder health.
• Regular Monitoring and Follow-Up:
  • Ongoing follow-up with a healthcare provider is important to monitor the effectiveness of treatment and make adjustments as needed.

Summary

The bladder neck is a crucial anatomical structure located at the junction between the bladder and the urethra. It functions as a sphincter, regulating urine flow and maintaining urinary continence by controlling the release of urine from the bladder. Anatomically, the bladder neck differs between men and women.

Diseases affecting the bladder neck include bladder neck obstruction (often due to an enlarged prostate in men or scarring in women), bladder neck contracture, and neurogenic bladder dysfunction. Symptoms of these conditions can include difficulty urinating, frequent urination, and urinary retention.

Diagnosis involves medical history, physical examination, and diagnostic tests such as urodynamic studies and cystoscopy. Treatment options vary depending on the underlying condition and severity. If surgery needs we usually do TUIP (transurethral incision of the prostate) operation successfully.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE