Name of the Procedure:

Cystourethroscopy with Irrigation and Evacuation of Multiple Obstructing Clots Common name(s): Bladder endoscopy, Clot evacuation via cystoscopy

Summary

A cystourethroscopy with irrigation and evacuation of multiple obstructing clots is a minimally invasive procedure in which a doctor uses a cystoscope (a thin, tube-like instrument with a camera) to view the inside of the bladder and urethra. The procedure includes flushing out and removing blood clots that are blocking the flow of urine.

Purpose

This procedure is primarily performed to address obstructive clot formation in the urinary bladder, which can lead to difficulty in urination or urinary retention. The goal is to remove the clots, relieve the blockage, and restore normal urine flow.

Indications

• Presence of visible blood in urine (hematuria) leading to clot formation.
• Urinary retention causing pain and discomfort.
• Difficulty in voiding despite a sensation of a full bladder.
• Confirmation of blood clots observed during imaging studies or previous cystoscopy.
• Recurrent episodes of hematuria leading to clot formation.

Preparation

• Patients may be instructed to fast for several hours prior to the procedure.
• Adjustments to medications, particularly blood thinners, should be made as per the doctor's advice.
• Pre-procedure urine and blood tests may be required to assess renal function and bleeding risk.
• An informed consent form will need to be signed prior to the procedure.

Procedure Description

1. The patient is positioned on the examination table, often in a lithotomy position.
2. Local anesthesia or sedation is administered to ensure comfort.
3. A lubricated cystoscope is gently inserted through the urethra into the bladder.
4. The bladder is filled with a sterile saline solution to expand it, providing a clear view.
5. The doctor inspects the bladder interior and identifies the blood clots.
6. Saline irrigation is used to flush out the clots, which are then evacuated using specialized instruments.
7. Continuous observation ensures all clots are removed, and any sources of bleeding are managed.
8. The cystoscope is withdrawn, and the patient is monitored briefly for any immediate post-procedure complications.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the extent to which clots need to be removed.

Setting

The procedure is usually performed in a hospital, surgical center, or outpatient clinic equipped with appropriate endoscopic facilities.

Personnel

• Urologist or a trained surgeon.
• Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is used).
• Nursing staff for assistance and patient monitoring.

Risks and Complications

• Discomfort or pain during and after the procedure.
• Urinary tract infection.
• Bleeding or recurrent hematuria.
• Injury to the urethra or bladder.
• Rarely, complications from anesthesia if used.

Benefits

• Immediate relief from urinary obstruction and discomfort.
• Restoration of normal urinary flow.
• Early resolution of symptoms caused by clot retention.
• Potential identification and management of the source of bleeding.

Recovery

• Patients may experience mild discomfort or a burning sensation during urination for a few days.
• Drinking plenty of fluids is often recommended to prevent clot reformation.
• Patients may need to refrain from strenuous activities and heavy lifting for a short period.
• Follow-up appointments are usually scheduled to monitor recovery and ensure no recurrence of symptoms.

Alternatives

• Conservative management with catheterization to temporarily relieve urinary retention.
• Medication to reduce bleeding and clot formation.
• Open surgical procedure for severe cases, though it carries higher risks compared to cystoscopy.
• Each alternative has its own risk-benefit profile which should be discussed with the healthcare provider.

Patient Experience

Patients may feel pressure or mild discomfort during the insertion of the cystoscope. After the procedure, some may experience a burning sensation or mild pain during urination. Pain management will include oral pain relievers, and the use of warm compresses can help alleviate discomfort. Most patients can resume normal activities within a few days.