Name of the Procedure:

Cystourethroscopy, with Ureteroscopy and/or Pyeloscopy; with Biopsy and/or Fulguration of Ureteral or Renal Pelvic Lesion

Summary

This is a procedure where a doctor examines the bladder, urethra, ureters, and renal pelvis using a special scope. They can also take a tissue sample (biopsy) or remove abnormal tissue (fulguration) during the same procedure.

Purpose

The procedure is used to diagnose and treat abnormalities in the urinary tract, including tumors, strictures, and other lesions. The goal is to identify the issue and potentially remove or treat the abnormal tissue to prevent further complications.

Indications

• Blood in urine (hematuria)
• Recurrent urinary tract infections
• Suspected tumors or lesions in the urinary tract
• Difficulty urinating or painful urination
• Abnormal findings in imaging tests (e.g., ultrasound, CT scan)

Preparation

• Patients are often instructed to fast for a few hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• A urine sample may be required for testing prior to the procedure.

Procedure Description

1. The patient is given anesthesia or sedation to ensure comfort.
2. A cystoscope is inserted through the urethra to examine the bladder.
3. If needed, a ureteroscope is passed through the cystoscope into the ureters and renal pelvis to inspect these areas.
4. Biopsies may be taken, or lesions may be fulgurated using specialized instruments.
5. The scopes are then carefully removed.

Duration

The procedure typically lasts between 30 to 90 minutes, depending on its complexity.

Setting

The procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist or nurse anesthetist
• Nursing staff or surgical technologists

Risks and Complications

• Infection
• Bleeding or blood clots
• Injury to the urinary tract (urethra, bladder, ureters, or kidneys)
• Pain or discomfort
• Rarely, anesthesia-related complications

Benefits

• Accurate diagnosis of urinary tract issues
• Direct treatment of lesions or tumors, reducing the need for additional surgeries
• Relief from urinary symptoms once the underlying issue is addressed

Recovery

• Patients can often go home the same day.
• Mild burning or discomfort during urination may occur but usually resolves in a few days.
• Drinking plenty of fluids is encouraged to flush out the urinary tract.
• Follow-up appointments are typically scheduled to review biopsy results and monitor recovery.

Alternatives

• Imaging tests (ultrasound, CT, MRI) for diagnostic purposes only
• Medications to manage symptoms, though they may not treat the underlying cause
• Open surgery for larger or more complicated lesions

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Post-procedure, some discomfort or mild burning during urination is common, but pain management measures like over-the-counter pain relievers can help. Most patients can resume normal activities within a couple of days, though heavy lifting and strenuous activities should be avoided for a short period.