Name of the Procedure:

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands.

Summary

Cystourethroscopy is a medical procedure that involves examining the inside of the bladder and urethra using a specialized instrument called a cystoscope. During this procedure, fulguration (a method of destroying tissue) may be performed using tools like a laser, cryosurgery device, or electrocautery at specific areas such as the bladder neck, prostatic fossa, urethra, or periurethral glands.

Purpose

This procedure is used to diagnose and treat various conditions affecting the bladder, urethra, and surrounding tissues. The goals include identifying abnormalities, removing or treating cancerous growths, sealing bleeding areas, or relieving blockages and symptoms associated with urinary function.

Indications

• Recurrent urinary tract infections
• Bladder or urethral abnormalities detected via imaging
• Hematuria (blood in urine)
• Urinary obstruction or difficulty urinating
• Painful urination or chronic pelvic pain
• Evaluation of the prostate (in males)

Preparation

• Follow fasting instructions, typically no food or drink for a specified period before the procedure.
• Adjustments to medications as advised by the healthcare provider, particularly blood thinners.
• Pre-procedure urine tests or imaging studies like ultrasound or CT scan may be required.

Procedure Description

1. The patient is positioned appropriately, usually lying on their back.
2. Anesthesia (local, regional, or general) is administered depending on the case and patient comfort.
3. A lubricated cystoscope is gently inserted through the urethra into the bladder.
4. The bladder is filled with a sterile solution to expand it and provide a better view.
5. The surgeon examines the bladder and urethra, identifying any abnormalities.
6. If fulguration is needed, a specialized tool (laser, cryotherapy device, or electrocautery) is passed through the cystoscope to treat the targeted areas.
7. After the procedure, the instruments are removed, and the patient is monitored during recovery.

Duration

The entire procedure typically takes about 30 to 60 minutes, depending on the complexity and whether additional treatments are performed.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or surgical specialist
• Nursing staff
• Anesthesiologist (if general or regional anesthesia is used)
• Surgical assistants

Risks and Complications

• Infection of the urinary tract
• Bleeding or hematuria
• Injury or perforation of the bladder or urethra
• Pain or discomfort during urination
• Rarely, stricture (narrowing) of the urethra

Benefits

• Accurate diagnosis of urinary tract issues
• Effective treatment of lesions or abnormalities
• Symptom relief and improved urinary function
• Prevention of recurrence of certain conditions

Recovery

• Patients may experience mild discomfort or burning during urination, usually resolving within a few days.
• Drinking plenty of fluids helps to flush the bladder.
• Avoid heavy lifting and strenuous activities for a short period.
• Follow-up appointments to monitor recovery and effectiveness of the procedure.

Alternatives

• Medications: antibiotics or other drugs for symptom management.
• Imaging studies: ultrasound, CT, or MRI scans for diagnosis.
• Open or laparoscopic surgery for certain conditions if cystourethroscopy is not suitable.

Patient Experience

• Patients may feel slight discomfort during insertion of the cystoscope.
• Pain management includes medications as needed pre- and post-procedure.
• Some patients may experience blood in their urine or a burning sensation when urinating temporarily after the procedure.