Name of the Procedure:

Excision or Fulguration of Carcinoma of the Urethra
Common name(s): Urethral tumor removal
Technical terms: Urethral carcinoma excision, Urethral fulguration

Summary

This procedure involves surgically removing or destroying cancerous tissue in the urethra. Fulguration uses electric current to eliminate the cancer cells. The goal is to treat urethral carcinoma while preserving as much of the healthy urethra as possible.

Purpose

Condition/Problem: Urethral carcinoma, a type of cancer that develops in the tissues of the urethra.
Goals/Outcomes: The primary goal is to remove or destroy cancerous cells to prevent the spread of the disease and alleviate any associated symptoms.

Indications

Symptoms/Conditions:

• Blood in the urine
• Painful urination
• Difficulty urinating
• Unusual discharge from the urethra

Patient Criteria:

• Diagnosed with urethral carcinoma
• Symptoms impacting quality of life
• No contraindications for surgery or anesthesia

Preparation

Pre-procedure Instructions:

• Fasting for 6-8 hours before the procedure
• Discontinue certain medications as advised (e.g., blood thinners)
• Arrive with an empty bladder

Diagnostic Tests/Assessments:

• Urinalysis
• Urethroscopy
• Biopsy of the affected tissue
• Imaging studies (e.g., MRI, CT scan)

Procedure Description

1. Anesthesia: Patient is given either general or regional anesthesia.
2. Positioning: Patient is positioned appropriately to access the urethra.
3. Excision/Fulguration:
   • Excision: The surgeon makes an incision and carefully removes the cancerous tissue.
   • Fulguration: A special instrument is used to apply an electric current to the cancerous areas, destroying the cells.
4. Closure: The surgical site is closed with sutures if an incision was made.

Tools/Equipment: Scalpels, electrocautery devices, urethroscope, biopsy forceps.

Duration

Typically, the procedure lasts between 1 to 3 hours, depending on the extent of the cancer and the complexity of the case.

Setting

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

Personnel

• Surgeons: Urologist or surgical oncologist
• Nurses: Operating room and recovery nurses
• Anesthesiologist: Administers anesthesia and monitors the patient

Risks and Complications

Common Risks:

• Bleeding
• Infection
• Pain at the surgical site

Rare Risks:

• Urethral stricture (narrowing of the urethra)
• Recurrence of carcinoma
• Incontinence or urinary retention

Management: Most risks are managed with medications, follow-up care, and additional procedures if necessary.

Benefits

• Removal or destruction of cancerous tissue
• Relief from related symptoms (e.g., pain, difficulty urinating)
• Improved prognosis and quality of life

Realization: Benefits are often realized shortly after recovery, though ongoing monitoring is necessary.

Recovery

Post-Procedure Care:

• Pain management with prescribed medications
• Instructions on wound care and hygiene
• Drink plenty of fluids to flush the urinary system

Expected Recovery Time:

• Initial recovery: 1-2 weeks
• Full recovery: A few weeks to a couple of months, depending on extent of surgery

Restrictions/Follow-Up:

• Avoid heavy lifting and strenuous activities for a few weeks
• Follow-up appointments for monitoring and additional treatments if necessary

Alternatives

Other Treatment Options:

• Radiation therapy: Non-invasive but may have side effects
• Chemotherapy: Systemic treatment, generally for advanced cases

Pros and Cons:

• Radiation and chemotherapy may have broader systemic effects, while surgery is localized and focused.
• Surgery offers direct removal of the tumor but comes with surgical risks.

Patient Experience

During Procedure: Under anesthesia, the patient will not be aware of the procedure.

After Procedure:

• Mild to moderate pain managed with medication
• Possible temporary urinary discomfort or catheter use
• Gradual return to normal activities
• Follow-up visits for progress assessment and additional care if needed

Pain management, caring medical staff, and honest communication help make the experience as comfortable as possible.