Name of the Procedure:

Cystourethroscopy with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography (male or female).

Summary

Cystourethroscopy is a medical procedure used to examine the interior surfaces of the bladder and urethra. The procedure often includes the calibration or dilation of narrowed sections of the urethra (strictures or stenosis). It may also involve a minor incision (meatotomy) and the injection of contrast material for imaging (cystography).

Purpose

This procedure addresses conditions such as urethral strictures or stenosis, where the urethra becomes narrowed, causing difficulty in urination. The goal is to widen these narrowings to improve urine flow and alleviate associated symptoms.

Indications

• Difficulty in urination or weak urine stream
• Recurrent urinary tract infections (UTIs)
• Persistent urinary symptoms not responding to conservative treatments
• Documented urethral strictures or stenosis from prior imaging or cystoscopy

Preparation

• Patients may be instructed to fast for a few hours prior to the procedure.
• Certain medications (blood thinners) might need to be paused.
• A urinalysis or urine culture may be performed to check for infections.

Procedure Description

1. The patient is typically placed in the lithotomy position.
2. Anesthesia: Local anesthesia, sedation, or general anesthesia may be used depending on the extent of the procedure.
3. A cystoscope (a thin, tube-like instrument with a camera and light) is inserted through the urethra to visualize the urinary tract.
4. Calibration: A graduated series of dilators may be used to measure the extent of the narrowing.
5. Dilation: The narrowed sections are gradually widened using specialized instruments.
6. Meatotomy: If needed, a small incision is made to widen the urethral opening.
7. Cystography: If indicated, a contrast agent is injected, and X-ray images are taken.
8. The instruments are removed, and the patient is monitored for a short period.

Duration

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

Setting

Cystourethroscopy is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or trained surgeon
• Nurses or medical assistants
• Anesthesiologist or nurse anesthetist (if sedation or general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Pain or discomfort
• Urethral injury or perforation
• Temporary difficulty in urination following the procedure
• Rarely, stricture may recur, requiring repeat procedures

Benefits

• Improved urine flow
• Relief from urinary symptoms, such as straining or weak stream
• Reduced risk of recurrent UTIs
• Better quality of life

Recovery

• Patients are usually able to go home the same day.
• Mild discomfort or burning sensation during urination may be experienced for a few days.
• Drink plenty of fluids to flush out the bladder.
• Avoid strenuous activities for a few days.
• Follow-up appointments will be scheduled to monitor progress.

Alternatives

• Conservative management with medication
• Periodic catheterization to relieve obstruction
• Open surgical repair for severe cases
• Each alternative has its own set of risks and benefits compared to cystourethroscopy.

Patient Experience

During the procedure, patients may feel mild discomfort, especially during dilation. Post-procedure, they might experience some burning or mild pain during urination. Pain management options (e.g., oral pain relievers) will be provided to ensure comfort.