Clinical Context
A typical patient is a 68-year-old male with bothersome lower urinary tract symptoms and recurrent episodes of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) and symptomatic bladder neck/trigonal lesions. The urologist evaluates the patient in clinic, reviews prior imaging (ultrasound or CT) and uroflowmetry, and documents failed conservative therapy (alpha-blocker and 5-alpha-reductase inhibitor) and persistent urinary retention or recurrent urinary tract infections. After preoperative assessment and informed consent, the patient is scheduled for a transurethral endoscopic procedure in an outpatient ambulatory surgery center or hospital operating room under general or spinal anesthesia.
During the procedure, the surgeon inserts a cystoscope through the urethra to visualize the bladder, bladder neck, trigone, prostatic fossa, periurethral glands, and urethra. The surgeon performs destruction (fulguration, electrocautery, cryotherapy, or laser ablation) of focal tissue on the bladder trigone, bladder neck, prostatic fossa, urethra, and/or periurethral glands to treat lesions contributing to obstruction, bleeding, or recurrent infections. Typical intraoperative documentation includes indication, cystoscopic findings, method of tissue destruction (electrocautery, laser, or cryo), duration, estimated blood loss, any complications, and postoperative catheter plan. Postoperative workflow includes recovery unit monitoring, voiding trial or catheter management, discharge instructions, and follow-up visit for symptom assessment and possible repeat cystoscopy if symptoms persist.