Bladder Neck Incision (BNI)
Endoscopic incision of a tight bladder neck to relieve obstruction and restore urinary flow — day-case procedure for young men with bladder neck obstruction, preserving antegrade ejaculation.
What is Bladder Neck Incision (BNI)?
Bladder Neck Incision (BNI) is an endoscopic procedure in which one or two incisions are made in the bladder neck using a cold knife, diathermy, or holmium laser to relieve functional or anatomical bladder neck obstruction. It is the preferred treatment for primary bladder neck obstruction in young men — a condition where the bladder neck fails to open adequately during voiding despite the absence of significant prostatic enlargement. BNI avoids the tissue resection and significant retrograde ejaculation rates of TURP, making it particularly appropriate for men of reproductive age who wish to preserve antegrade ejaculation and fertility.
How the Procedure Works
Cystoscopic Assessment
Cystoscope introduced; bladder neck anatomy assessed and degree of closure during filling confirmed before incision position planned.
Landmark Identification
Bladder neck, verumontanum, and ureteric orifices identified; incision must remain proximal to verumontanum to avoid sphincter injury.
Bladder Neck Incision
One or two incisions made at 5 and 7 o'clock positions through bladder neck using cold knife, diathermy, or holmium laser.
Adequacy Assessment
Cystoscope advanced to confirm widening of bladder neck lumen; incisions deepened if inadequate opening achieved at initial assessment.
Catheter & Discharge
16–18 Fr catheter placed for 24 hours; removed next morning with voiding trial; discharge once satisfactory voiding confirmed.
Outcomes
Who Needs This Treatment?
- →Young men under 40–50 with primary bladder neck obstruction and a small or normal-sized prostate.
- →Those with urodynamically confirmed bladder neck obstruction who want to preserve antegrade ejaculation.
- →Men with bladder neck contracture following prostatectomy, prostate brachytherapy, or other pelvic surgery.
- →Patients with obstruction caused by a high bladder neck rather than prostatic adenoma enlargement.
- →Those in whom TURP would carry disproportionate risk of retrograde ejaculation given their age and fertility status.
- →Men with post-TURP bladder neck contracture causing recurrent obstruction requiring secondary incision.
"BNI is the ideal treatment for young men with primary bladder neck obstruction — it relieves the obstruction effectively while preserving ejaculation and fertility, which TURP cannot reliably guarantee for men of reproductive age."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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