Bladder fulguration is a minimally invasive medical procedure that uses a high-frequency electrical current to destroy targeted abnormal tissue within the bladder. This technique, a type of electrosurgery, is commonly performed by a urologist to treat various conditions affecting the bladder lining. Since it is delivered without a surgical incision, it offers a less invasive alternative for managing lesions and growths inside the urinary bladder.
The Mechanism of Fulguration
Fulguration is a specific application of electrocautery, which relies on generating heat to achieve precise tissue destruction. The procedure utilizes a specialized electrosurgical generator that produces a high-frequency, alternating electrical current, often in the radiofrequency range. This current is delivered to the target tissue via a small electrode, typically passed through a cystoscope.
As the electrical energy contacts the tissue, it creates a spark that rapidly generates intense heat on the surface layer of the cells. This heat causes the localized destruction or ablation of the abnormal tissue. A secondary function of this heat is the cauterization of small blood vessels in the area, which helps to minimize or stop bleeding immediately after the tissue is destroyed.
The electrical discharge is controlled to ensure that only the surface layers are treated, protecting the deeper muscle layers of the bladder wall. This precision allows the physician to treat superficial lesions effectively while mitigating the risk of deep tissue injury.
Bladder Conditions Treated
Fulguration is most often employed as part of the treatment for superficial, non-muscle-invasive bladder cancer. It is frequently used following the removal of a bladder tumor, known as transurethral resection of bladder tumor (TURBT), to destroy any remaining cancer cells and to control bleeding at the tumor site. This technique is a crucial component in managing early-stage cancers, where the abnormal cells have not yet penetrated the deeper muscle layers of the bladder wall.
The procedure is also used to manage chronic bleeding conditions, such as hemorrhagic cystitis, which can be a side effect of prior radiation or chemotherapy. By cauterizing the bleeding vessels, fulguration can provide symptomatic relief. Furthermore, it is effective for treating benign growths or lesions, including small polyps or ulcers, such as Hunner’s lesions associated with interstitial cystitis.
Fulguration may also be considered for certain cases of recurrent urinary tract infections (UTIs) that are unresponsive to standard antibiotic treatment. In these instances, the procedure targets chronic inflammatory lesions or abnormal tissue believed to harbor bacteria or contribute to the recurring infection.
What to Expect During the Procedure
The fulguration procedure is typically performed in an outpatient setting. Before the procedure begins, patients are usually instructed to fast for a set period and may be given preventative antibiotics. Anesthesia is administered, which can range from local to regional (spinal) or general anesthesia, depending on the extent of the treatment and the patient’s overall health.
Once the patient is positioned, the urologist inserts a specialized instrument called a cystoscope through the urethra and into the bladder. Because the procedure is performed transurethrally, no external surgical incision is required. The bladder is then gently filled with a sterile fluid to distend the walls, allowing the physician a clear view of the bladder lining via the camera on the cystoscope.
The urologist visually identifies the abnormal tissue or bleeding site using the cystoscope’s optics. The fulguration electrode is then passed through the cystoscope, and the high-frequency electrical current is precisely applied to the target area. The procedure generally takes less than an hour, although the duration depends on the size and number of areas requiring treatment.
Post-Procedure Care and Recovery
After the fulguration procedure is complete, the patient is moved to a recovery area for monitoring as the effects of the anesthesia wear off. Many patients are able to return home after a few hours of observation. Because the urinary tract has been instrumented, it is common to experience some temporary side effects during the initial recovery period.
Patients often report a mild burning sensation or discomfort when urinating, known as dysuria, and an increased frequency or urgency to urinate. Blood in the urine (hematuria) is also expected, typically appearing pink or light red for a few days as the treated area heals. This usually resolves within a week, but increased fluid intake is recommended to help flush the bladder.
Pain medication may be prescribed to manage discomfort. Most individuals can resume light daily activities within a few days, though strenuous activities and heavy lifting are restricted for one to two weeks. Patients should contact their healthcare provider immediately if they experience a fever, severe pain, an inability to urinate, or heavy bleeding with large blood clots.