Name of the Procedure:

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of large bladder tumor(s).

Summary

This procedure involves using a thin, flexible tube equipped with a camera (cystoscope) to view the inside of the bladder and urethra. It includes the removal of large bladder tumors using specialized techniques such as electrical fulguration, cryosurgery, or laser surgery.

Purpose

The procedure addresses bladder cancer by removing large tumors from the bladder. The goal is to eliminate cancerous growths, prevent recurrence, and preserve bladder function.

Indications

• Symptoms like blood in the urine (hematuria), frequent urination, or painful urination.
• Diagnosis of bladder tumors through imaging or other diagnostic tests.
• Previous identification of bladder tumors that require resection.

Preparation

• The patient may need to fast for several hours before the procedure.
• Adjustments to medications may be necessary, particularly blood thinners.
• Routine blood tests and urinalysis, and sometimes imaging tests like an ultrasound or CT scan.

Procedure Description

1. The patient is given anesthesia or sedation for comfort.
2. A cystoscope is gently inserted through the urethra into the bladder.
3. The surgeon examines the bladder for tumors.
4. Tumors are removed using fulguration (electrical current), cryosurgery (freezing), or laser surgery.

5. The bladder is irrigated and inspected for any remaining tumor cells.

   Tools and equipment include a cystoscope, fulguration device, cryosurgery probe, or laser equipment.

Duration

The procedure typically takes 30 minutes to 2 hours, depending on the size and number of tumors.

Setting

The procedure is performed in a hospital, usually in an operating room or a specialized surgical center.

Personnel

• Urologist or surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Common risks: bleeding, infection, pain during urination.
• Rare risks: damage to the bladder or urethra, blood clots, reactions to anesthesia.
• Management includes antibiotics for infection, pain medications, and close monitoring.

Benefits

• Removal of large bladder tumors.
• Potentially curative for bladder cancer.
• Relief from symptoms like hematuria and discomfort.

Benefits are often realized shortly after the procedure, with symptoms improving within days.

Recovery

• Initial recovery in a hospital or clinic for a few hours to monitor for complications.
• Instructions include drinking plenty of fluids, avoiding strenuous activity, and managing pain with prescribed medications.
• Recovery time is typically a few days to a week, with follow-up appointments to monitor for recurrence.

Alternatives

• Watchful waiting for small, asymptomatic tumors.
• Intravesical therapy (medications administered directly into the bladder).
• More invasive surgical options like partial or total cystectomy (removal of part or all of the bladder).

Alternatives vary in invasiveness, risks, and efficacy depending on the patient's condition.

Patient Experience

During the procedure, the patient will be under anesthesia and won't feel pain. Post-procedure, there might be discomfort, such as burning during urination or mild pain, managed with medications. Most patients can resume normal activities within a week, with ongoing monitoring and follow-up to ensure complete recovery.