Name of the Procedure:

Cystourethroscopy, with injection(s) for chemodenervation of the bladder

Summary

Cystourethroscopy with chemodenervation involves a visual examination of the bladder and urethra using a cystoscope, combined with injections of medication to relax the bladder muscles.

Purpose

This procedure primarily addresses bladder control issues, such as overactive bladder or urinary incontinence. The goal is to reduce bladder muscle contractions, thereby improving urinary control and comfort.

Indications

• Overactive bladder (OAB)
• Urinary incontinence not responsive to other treatments
• Neurogenic bladder disorders
• Chronic urinary retention

Preparation

• Fasting may be required several hours before the procedure.
• Adjustments to current medications (as advised by the healthcare provider).
• Pre-procedure testing, such as urinalysis or imaging studies, might be needed.
• Arranging transportation home after the procedure.

Procedure Description

1. The patient is placed in a lithotomy position.
2. Anesthesia or sedation is administered to ensure comfort.
3. A cystoscope is inserted into the urethra to visualize the bladder.
4. Sterile saline may be used to fill the bladder for better visualization.
5. Chemodenervation injections (e.g., botulinum toxin) are administered into the bladder wall.
6. The cystoscope is gently removed.

Duration

Approximately 30 minutes to 1 hour.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or medical assistants

Risks and Complications

• Mild discomfort or bladder spasms
• Urinary tract infection (UTI)
• Temporary difficulty urinating
• Rare allergic reaction to medication
• Bleeding at the injection sites
• Possible need for intermittent catheterization

Benefits

• Reduced urgency and frequency of urination
• Improved control over bladder function
• Increased comfort and quality of life

Recovery

• Patients may experience mild discomfort for a few days.
• Increased fluid intake is recommended to flush the bladder.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to monitor effectiveness and any side effects.
• Normal activities can usually be resumed within a day or two.

Alternatives

• Oral medications: Pros include non-invasiveness; cons include systemic side effects.
• Pelvic floor physical therapy: May improve muscle control but requires commitment and regular visits.
• Sacral nerve stimulation: Effective for some but involves implanting a device.
• Lifestyle modifications and bladder training: Helpful but may not be sufficient alone.

Patient Experience

During the procedure, the patient will be under anesthesia or sedation, ensuring little to no pain is felt. Post-procedure, mild bladder irritation and occasional hematuria (blood in urine) may occur but can be managed with hydration and mild pain relievers. Most patients find significant symptom relief within days to weeks.