Name of the Procedure:

Cystourethroscopy with Incision, Fulguration, or Resection of Congenital Posterior Urethral Valves or Congenital Obstructive Hypertrophic Mucosal Folds

Summary

The procedure involves using a cystoscope to visualize the urethra and bladder and then performing an incision, fulguration (electrical burning), or resection (surgical removal) to treat congenital obstructions like posterior urethral valves or hypertrophic mucosal folds that block urine flow.

Purpose

This procedure is primarily performed to treat congenital obstructions in the urethra that can hinder normal urine flow. The goals are to relieve the obstruction, prevent damage to the kidneys and bladder, and improve urinary function.

Indications

• Symptoms of urinary obstruction, such as weak urine flow, urinary tract infections, or difficulty urinating.
• Diagnosis of congenital posterior urethral valves or obstructive hypertrophic mucosal folds, usually confirmed through imaging studies or other diagnostic tests.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Medication adjustments, such as stopping blood thinners, might be necessary.
• Pre-procedure assessments could include urine tests, blood tests, and imaging studies like ultrasound or voiding cystourethrogram (VCUG).

Procedure Description

1. The patient is given anesthesia to ensure they are comfortable and pain-free during the procedure.
2. A cystoscope, a thin tube with a camera, is inserted through the urethra into the bladder.
3. The surgeon visualizes the urethra and bladder using the cystoscope.
4. Depending on the obstruction, an incision, fulguration, or resection is performed to remove or destroy the abnormal tissue.
5. The cystoscope is carefully removed.
6. A catheter might be placed temporarily to ensure proper urine flow post-procedure.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the obstruction.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Urologist or pediatric urologist
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to the urethra or bladder
• Scarring or narrowing of the urethra (stricture)
• Recurrence of the obstruction

Benefits

• Improved urine flow
• Prevention of kidney and bladder damage
• Resolution of symptoms like weak urine stream and urinary tract infections
• Benefits are typically realized shortly after the procedure once the initial healing has begun.

Recovery

• Patients may need to stay in the hospital for a short period for observation.
• Instructions on catheter care if a catheter is placed.
• Pain management may be necessary.
• Follow-up appointments to monitor healing and ensure the obstruction has been successfully treated.
• Most patients can resume normal activities within a few days to a week, depending on their condition and recovery.

Alternatives

• Observation and regular monitoring if symptoms are mild.
• Medication to manage symptoms, although this is typically not effective for anatomical obstructions.
• Open surgery, which is more invasive but may be necessary for complex cases.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-procedure, the patient might experience some discomfort or pain, managed with pain relievers.
• Temporary urinary catheterization may cause discomfort.
• Patients should expect some mild burning or urgency when urinating for a few days post-procedure.