1 Make sure the patient’s voiding dysfunction is well-controlled with behavioral and anticholinergic therapy.
2 The patient is placed in the carefully padded hanging stirrups. The camera (TV screen) is positioned around the patient’s right shoulder area so that it can be viewed from between the patient’s legs.
3 Do not open the Deflux until you are ready to inject, since the cost is 1,000 U.S. dollars per cubic centimeter (cc).
4 IV Gentamicin is given in the Operating Room pre-operatively.
5 A #12 French to #10 French scope is usually utilized with a 45 or 30 degree angulation.
6 The needle is flushed prior to placing it in the scope. This is done with saline solution. It is important not to inject any further saline after the Deflux has been inserted since saline may dissolve the Deflux.
7 1.0 cc is generally used per orifice, but 2.0 cc can be used if necessary, particularly on larger children.
8 A urine culture is obtained as soon as the scope is advanced in.
9 The needle is advanced in with the bevel upwards, and it is advanced inside the floor of the urethral orifice. There is a black mark on the needle indicating how far in it should be advanced. The bevel can be rotated in order to control where the injection is going, particularly if it seems to be extravasating laterally or medially. Once the injection is completed, the needle is left in place for about a minute and then withdrawn.
10 Once the needle is withdrawn, the scope is advanced into the orifice and the flush used with the cystoscope to see if you can balloon out the orifice. If so, perhaps more Deflux injection is necessary.
11 Do Not Run Fluid Through the Cystoscope While Injecting
12 Two-week follow-up is not generally necessary unless the patient is symptomatic. A phone call is perhaps worthwhile.
13 No follow-up ultrasounds are usually obtained unless patient is symptomatic.
14 A VCUG is obtained in three to four months and then again at one year.
15 On dictation of the Operative Report, remember to have the nurses check the urine culture results.
16 The bladder is decompressed when the procedure is completed.
17 Viscous Lidocaine is injected into the urethra when finished with the procedure.