Name of the Procedure:

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of medium bladder tumor(s) (2.0 to 5.0 cm).

Summary

Cystourethroscopy with fulguration or resection is a minimally invasive procedure to examine the bladder and urethra using a cystoscope and remove or destroy medium-sized bladder tumors. Techniques such as cryosurgery or laser surgery may be employed.

Purpose

This procedure aims to diagnose and treat bladder tumors measuring between 2.0 to 5.0 cm. Goals include removing cancerous tissues, relieving symptoms, preventing tumor growth, and improving bladder function.

Indications

• Presence of bladder tumors identified through imaging or previous cystoscopy.
• Symptoms such as blood in the urine (hematuria), frequent urination, or painful urination.
• Previous diagnosis of bladder cancer requiring further treatment.
• Criteria: Suitable for patients with medium-sized bladder tumors, typically 2.0 to 5.0 cm in diameter.

Preparation

• Fasting typically required for 6-8 hours before the procedure.
• Medication adjustments may be necessary (e.g., blood thinners).
• Pre-procedure tests: Urinalysis, blood tests, imaging studies, and sometimes an electrocardiogram (EKG).

Procedure Description

1. Preparation: Administer anesthesia (local, regional, or general).
2. Cystoscopy: Insert a cystoscope through the urethra into the bladder.
3. Examination: Visualize the bladder interior using the cystoscope.
4. Tumor Treatment: Use fulguration, cryosurgery, or laser surgery to destroy or resect tumors.
   • Fulguration: Apply electrical current to burn away the tumor.
   • Cryosurgery: Utilize extreme cold to freeze and destroy tumor cells.
   • Laser Surgery: Employ a laser to precisely cut and remove tumor tissue.
5. Completion: Remove the cystoscope and monitor the patient post-procedure.

Tools: Cystoscope, electrocautery equipment, cryosurgery apparatus, laser instrument. Anesthesia: Local, regional, or general anesthesia based on patient needs and tumor size/location.

Duration

The procedure typically takes 30 minutes to 1 hour, depending on the complexity.

Setting

Usually performed in a hospital or outpatient surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurse
• Technician (if specialized equipment is used)

Risks and Complications

• Infection
• Bleeding
• Perforation of the bladder or urethra
• Blood clots
• Adverse reactions to anesthesia
• Recurrence of the tumor

Benefits

• Effective removal or destruction of medium-sized bladder tumors.
• Symptom relief and improved quality of life.
• Reduced risk of tumor progression.
• Faster recovery compared to open surgery.

Recovery

• Post-procedure monitoring for several hours.
• Hydration to flush out the urinary system.
• Pain management with prescribed medications.
• Avoid strenuous activities for 1-2 weeks.
• Follow-up appointments to monitor recovery and assess for tumor recurrence.

Alternatives

• Open surgical resection (more invasive, longer recovery time).
• Chemotherapy or immunotherapy (less immediate results, systemic side effects).
• Active surveillance (risk of tumor growth).

Patient Experience

Patients might experience mild discomfort or pain during the procedure if under local anesthesia. Post-procedure, there might be a burning sensation during urination, blood in the urine, or mild abdominal pain. Pain usually managed through prescribed analgesics and comfort measures. Most patients can resume normal activities within a few days, adhering to any specific post-operative instructions from their healthcare provider.