0499T Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed

Name of the Procedure

Cystourethroscopy with Mechanical Dilation and Urethral Therapeutic Drug Delivery for Urethral Stricture or Stenosis, including Fluoroscopy (when performed)

Summary

Cystourethroscopy is a procedure where a thin, flexible tube with a camera (cystoscope) is inserted into the urethra to examine the bladder and urinary tract. When treating urethral strictures (narrowing of the urethra), mechanical dilation is performed to widen the urethra. Therapeutic drugs are then administered to help keep the urethra open. Fluoroscopy, a type of x-ray imaging, can be used to guide the procedure.

Purpose

This procedure is designed to treat urethral strictures or stenosis, which can cause difficulty in urination, urinary tract infections, or bladder issues. The goals are to widen the narrowed area, relieve symptoms, and prevent recurrence.

Indications

• Difficulty urinating or weak urine stream
• Recurrent urinary tract infections
• Bladder discomfort or pain
• Diagnostic imaging or previous tests indicating urethral stenosis or stricture

Preparation

• Fasting several hours prior if sedation is planned
• Adjustments to regular medications as advised (e.g., blood thinners may need to be stopped)
• Pre-procedure tests such as urine analysis or imaging studies

Procedure Description

1. The patient is positioned and prepared in a sterile manner.
2. Local anesthesia, sedation, or general anesthesia may be administered.
3. A cystoscope is inserted through the urethra into the bladder to visualize the area.
4. Mechanical dilation is performed using specialized instruments to widen the stricture.
5. Therapeutic drugs are delivered to the urethral area to minimize the risk of re-stenosis.
6. Fluoroscopy may be used to guide and confirm the effective dilation.
7. The cystoscope is removed, and the area is cleaned.

Duration

Approximately 30 minutes to 1 hour.

Setting

Typically performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or specialized surgeon
• Nurses or medical assistants
• Anesthesiologist (if general anesthesia or deep sedation is used)

Risks and Complications

• Infection
• Bleeding or blood in urine
• Pain or discomfort
• Urinary retention or difficulty urinating
• Rarely, urethral injury or perforation

Benefits

• Improved urinary flow
• Relief from urinary symptoms
• Prevention of recurrent strictures and associated complications
• Enhanced quality of life

Recovery

• Post-procedure instructions may include avoiding strenuous activities for a few days.
• Mild burning or discomfort during urination might occur temporarily.
• Follow-up appointments to monitor healing and effectiveness.
• Antibiotics or pain medications may be prescribed.

Alternatives

• Urethral stent placement
• Open surgical repair (urethroplasty)
• Periodic self-catheterization
• Drug treatments without mechanical dilation Each alternative has its own set of pros and cons; the choice depends on individual patient factors.

Patient Experience

• During the procedure, patients under local anesthesia may feel some pressure or discomfort.
• Post-procedure, there may be mild discomfort or a burning sensation when urinating.
• Effective pain management and comfort measures are taken to ensure minimal discomfort.