Name of the Procedure:

Cystourethroscopy for Treatment of Female Urethral Syndrome with Urethral Meatotomy, Urethral Dilation, Internal Urethrotomy, Lysis of Urethrovaginal Septal Fibrosis, Lateral Incisions of the Bladder Neck, and Fulguration

Summary

Cystourethroscopy is a medical procedure performed to diagnose and treat conditions affecting the urethra and bladder. It involves the use of a cystoscope, a thin tube with a camera, to view the inside of the urethra and bladder. For treating female urethral syndrome, additional interventions such as urethral meatotomy, dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral bladder neck incisions, and fulguration may be performed during the cystourethroscopy.

Purpose

This procedure addresses the medical condition called female urethral syndrome, which includes symptoms such as chronic pelvic pain, frequent and painful urination, and burning sensations. The goals are to relieve obstruction, reduce scar tissue, and alleviate symptoms by improving the function of the urethra and bladder.

Indications

• Chronic pelvic pain and discomfort
• Frequent urination
• Painful urination
• Recurrent urinary tract infections
• Urethral strictures or narrowings
• Presence of urethrovaginal septal fibrosis

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Pre-procedure diagnostic tests such as urine analysis or imaging studies may be required.
• The patient will need to void their bladder prior to the procedure.

Procedure Description

1. The patient is positioned on the examination table.
2. Local or general anesthesia is administered for comfort.
3. A cystoscope is gently inserted into the urethra and advanced into the bladder.
4. The internal structures are inspected, and any strictures, fibrosis, or other abnormalities are identified.
5. Urethral meatotomy or dilation is performed if there are obstructions.
6. Internal urethrotomy may be conducted to cut through scar tissue in the urethra.
7. Lysis of urethrovaginal septal fibrosis involves cutting away fibrous tissue.
8. Lateral incisions in the bladder neck may be made to widen the urethral passage.
9. Fulguration involves using electric current to burn away abnormal tissue.
10. The cystoscope is withdrawn, and the procedure is completed.

Duration

The procedure typically takes about 30 minutes to 1 hour, depending on the complexity and interventions required.

Setting

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

Personnel

• Urologic surgeon
• Anesthesiologist (if general anesthesia is used)
• Nursing staff
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Injury to the urethra or bladder
• Urinary retention
• Scar tissue formation
• Pain or discomfort
• Rare anesthesia-related complications

Benefits

• Relief from chronic pain and discomfort
• Improved urinary function
• Reduced frequency and urgency of urination
• Lower risk of recurrent urinary tract infections
• Enhanced quality of life

Recovery

• Patients may experience mild discomfort or a burning sensation during urination for a few days.
• Drinking plenty of fluids helps to flush out the bladder.
• Antibiotics may be prescribed to prevent infection.
• Follow-up appointments are necessary to monitor healing and progress.
• Most patients can resume normal activities within a few days, but strenuous activities should be avoided for a week.

Alternatives

• Conservative management with medications and lifestyle changes
• Pelvic floor physical therapy
• Devices such as urethral dilators
• More invasive surgical options for severe cases

Patient Experience

During the procedure, the patient is generally comfortable due to anesthesia. After the procedure, there may be some discomfort, burning sensation during urination, and a possible need for pain management. Patients are advised on comfort measures and given clear instructions for care at home.