A high bladder neck refers to a condition where the opening of the bladder into the urethra is positioned higher than normal. This can lead to difficulties in urination, such as incomplete emptying of the bladder or urinary retention. One treatment option for this condition is using a holmium laser. The holmium laser is a precise surgical tool that can be used to make precise incisions or ablate tissue.

Treatment with holmium laser

A high bladder neck is a condition where the opening of the bladder into the urethra is positioned higher than normal, causing urinary difficulties. Treatment with a holmium laser involves using this precise surgical tool to reshape the tissue around the bladder neck, improving urinary flow and relieving symptoms. This minimally invasive procedure is performed under anesthesia and offers faster recovery and improved urinary function compared to traditional methods.

Before operation

Before undergoing treatment for a high bladder neck with a holmium laser, several steps are typically involved to ensure the procedure’s safety and effectiveness:

• Medical Evaluation: The patient undergoes a comprehensive medical evaluation, including a physical examination and possibly imaging tests such as ultrasound or cystoscopy, to assess the severity of the high bladder neck and its impact on urinary function.
• Discussion with Urologist: The patient discusses their symptoms, medical history, and treatment options with their healthcare provider. This conversation may involve explaining the risks and benefits of the procedure, as well as discussing any alternative treatments available.
• Preoperative Instructions: The patient receives specific instructions from their healthcare provider regarding preoperative preparations. This may include fasting for a certain period before the procedure, discontinuing certain medications that could interfere with anesthesia or blood clotting, and instructions for bowel preparation if necessary.
• Anesthesia Consultation: If general anesthesia is required for the procedure, the patient may need to undergo a preoperative anesthesia consultation to assess their overall health and determine the most suitable anesthesia plan.
• Consent: Before the procedure, the patient provides informed consent, indicating that they understand the purpose of the procedure, its potential risks and benefits, and alternative treatment options.
• Preoperative Testing: Depending on the patient’s medical history and overall health, additional preoperative testing such as blood tests, electrocardiogram (ECG), or chest X-ray may be ordered to ensure they are medically fit for surgery.
• Arrangements for Recovery: Patients may need to arrange for transportation to and from the hospital or surgical center on the day of the procedure. They should also make arrangements for someone to assist them during the initial recovery period at home, as they may experience temporary discomfort or restrictions on activities.
• Addressing Concerns and Questions: Patients are encouraged to ask any questions or express any concerns they may have about the procedure or recovery process to their healthcare provider before the operation.

How to do operation?

The treatment of a high bladder neck using a holmium laser involves a minimally invasive surgical procedure called “bladder neck incision.” Here’s an overview of the steps involved:

• Preparation: The patient is typically placed under general anesthesia or regional anesthesia to ensure comfort and pain management during the procedure.
• Cystoscopy: A cystoscope, a thin tube with a camera, is inserted through the urethra into the bladder. This allows the surgeon to visualize the bladder neck and surrounding tissue on a monitor.
• Identification of the High Bladder Neck: The surgeon identifies the location of the high bladder neck and evaluates its size and configuration.
• Holmium Laser Incision: Using a holmium laser, the surgeon makes precise incisions at 05 and 07 o’clock position around the bladder neck. These incisions are designed to lower the bladder neck and improve urinary flow.
• Monitoring and Adjustment: Throughout the procedure, the surgeon monitors the progress and may make adjustments as necessary to achieve the desired outcome.
• Completion and Recovery: Once the incisions are made, the cystoscope is removed, urethral cathether inserted into the urethra and the patient is taken to the recovery room. Recovery time varies but is typically shorter compared to traditional surgical methods.

After the procedure, patients may experience some discomfort or mild urinary symptoms, which can be managed with medications as needed. It’s essential to follow post-operative care instructions provided by the medical team to ensure proper healing and optimal outcomes.

Complications

While treatment of a high bladder neck with a holmium laser is generally considered safe and effective, like any medical procedure, it carries some potential risks and complications. Here are some possible complications associated with this treatment:

• Bleeding
• Infection
• Urinary Retention
• Urinary Incontinence
• Bladder Injury
• Scar Tissue Formation
• Voiding Dysfunction
• Retrograde ejaculation

Retrograde ejaculation is a potential complication that can occur after treatment with a holmium laser for a high bladder neck. This condition occurs when semen enters the bladder instead of being expelled through the urethra during ejaculation. After bladder neck surgery this complication ranges from approximately 20% to 70%. In our cases, this condition is exceedinly rare.

Summary

High bladder neck is a condition where the opening of the bladder into the urethra is positioned higher than normal, causing urinary difficulties. Treatment with a holmium laser involves a minimally invasive procedure called bladder neck incision. During this procedure, precise incisions or tissue removal are made around the bladder neck using a holmium laser to improve urinary flow. This approach offers faster recovery and improved urinary function compared to traditional methods. Proper preoperative evaluation and patient preparation are essential for ensuring the safety and effectiveness of the procedure.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE