Name of the Procedure:

Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated.

Summary

Cystourethroscopy is a medical procedure where a thin, flexible tube called a cystoscope is used to visualize the inside of the urethra and bladder. This specific procedure involves removing foreign bodies, calculi (stones), or ureteral stents from the urinary tract, and is considered complicated due to factors like the size, location, or nature of the obstruction.

Purpose

This procedure addresses issues such as the presence of foreign objects, stones, or malfunctioning stents in the urethra or bladder. The main goals are to relieve symptoms, prevent infection, and restore normal urinary function.

Indications

The procedure is recommended for patients experiencing:

• Severe pain in the pelvic region.
• Difficulty or inability to urinate.
• Recurrent urinary tract infections.
• Visible blood in urine (hematuria).
• Situations where previously placed stents need to be removed or replaced.

Preparation

Patients may be instructed to:

• Fast for at least 6-8 hours prior to the procedure.
• Adjust current medications as advised by their healthcare provider.
• Undergo diagnostic tests such as urine analysis, blood tests, or imaging studies like ultrasounds or CT scans.

Procedure Description

1. The patient is made to lie on the examination table and provided with regional or general anesthesia.
2. A cystoscope is gently inserted through the urethra into the bladder.
3. Saline solution is used to distend the bladder for better visualization.
4. Using specialized instruments passed through the cystoscope, the surgeon identifies and removes the foreign body, calculus, or stent.
5. The area is inspected for any residual fragments or complications.
6. Once completed, the instruments are removed, and the patient is taken to recovery.

Duration

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

Setting

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

Personnel

The healthcare team generally includes a urologist or surgeon, a nurse, and an anesthesiologist.

Risks and Complications

Common risks include:

• Minor bleeding or infection.
• Discomfort or pain during urination post-procedure. Rare complications may include:
• Perforation of the bladder or urethra.
• Severe infections like urosepsis.
• Strictures or scarring in the urethra.

Benefits

The expected benefits are the removal of the problematic object or stent, relief from pain or other symptoms, and prevention of recurrent infections. Benefits are typically realized immediately or within a few days post-procedure.

Recovery

Post-procedure care may include:

• Monitoring in a recovery area to ensure there are no immediate complications.
• Instructions on hydration and medications for pain or infection prevention.
• Avoidance of strenuous activities for a specified period, usually a week.
• A follow-up appointment to check on healing and ensure no complications.

Alternatives

Alternative treatments might include:

• Non-invasive extracorporeal shock wave lithotripsy (ESWL) for stones.
• Medication management for mild cases.
• Observation in cases where immediate removal isn’t warranted.

Each alternative has its pros and cons, such as lower risk but longer treatment duration for ESWL.

Patient Experience

Patients may feel some discomfort or pressure during the procedure, especially if regional anesthesia is used. Post-procedure, they might experience mild pain during urination and should receive guidance on pain management. Comfort measures like drinking plenty of fluids can help alleviate these symptoms.