Name of the Procedure:

Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and/or resection of small bladder tumor(s) (0.5 up to 2.0 cm)

Summary

Cystourethroscopy, combined with fulguration or resection, is a procedure used to diagnose and treat small bladder tumors. A cystoscope, a thin tube with a camera, is inserted through the urethra to view the bladder. Fulguration uses electricity, cryosurgery uses freezing temperatures, and laser surgery uses focused light to remove or destroy tumors.

Purpose

The procedure is used to remove or destroy small bladder tumors to prevent them from growing or spreading. It helps to preserve bladder function and reduce symptoms such as blood in the urine, urinary urgency, or pain during urination.

Indications

• Presence of small bladder tumors (0.5 up to 2.0 cm) detected through imaging or urine cytology.
• Symptoms like hematuria (blood in the urine), frequent urination, or painful urination.
• High risk of tumor growth or recurrence.
• Patient is a good candidate based on overall health and medical history.

Preparation

• Fasting for 6-8 hours prior to the procedure if anesthesia will be used.
• Adjustments in blood-thinning medications as advised by the doctor.
• Routine blood tests and urine analysis.
• Imaging studies like ultrasound or CT scan for precise tumor localization.

Procedure Description

1. The patient is positioned on the examination table.
2. Anesthesia (local, spinal, or general) is administered as required.
3. The cystoscope is gently inserted through the urethra into the bladder.
4. The bladder is filled with a sterile solution to allow better visualization.
5. Tumors are identified and either fulgurated, frozen, or resected using the appropriate tool attached to the cystoscope.
6. The treated area is examined for bleeding, and necessary measures are taken to control it.
7. The cystoscope is withdrawn, and the patient is monitored for any immediate complications.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

The procedure is generally performed in a hospital or outpatient surgical center.

Personnel

• Urologist or surgeon performing the procedure.
• Nurse assisting with the procedure.
• Anesthesiologist (if sedation or general anesthesia is used).

Risks and Complications

• Common: Mild burning during urination, blood in urine, frequent urination.
• Rare: Infection, significant bleeding, bladder perforation, reaction to anesthesia, urinary retention.

Benefits

• Effective removal or destruction of small bladder tumors.
• Quick recovery with minimal risk of severe complications.
• Preservation of bladder function and reduction of symptoms.

Recovery

• Patients can often go home the same day.
• Drink plenty of fluids to flush the bladder.
• Avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments to monitor healing and ensure no tumor recurrence.
• Temporary use of pain relievers and antibiotics as prescribed.

Alternatives

• Observation with regular monitoring for smaller, non-symptomatic tumors.
• Intravesical therapy (medications administered directly into the bladder).
• More invasive surgery for larger or aggressive tumors.
• Radiation or chemotherapy for advanced cases.

Patient Experience

During the procedure, if local anesthesia is used, the patient may feel some pressure or mild discomfort. General anesthesia will make the patient unconscious and unaware. Post-procedure, there may be mild burning sensation during urination, blood in the urine, or frequent urges to urinate, which typically resolve in a few days. Pain can generally be managed with over-the-counter pain relief or prescribed medications.