Bladder Fulguration Risks, Recovery And Costs: Philippe Zimmern, M.D. (Part 4)

Dr. Zimmern shares that the majority of people will heal after fulguration without problems. However, like any medical procedure, it is not completely risk-free. This is why he ensures that there are no other options before recommending fulguration.
To avoid the risk of introducing infection to the bladder during cystoscopy, Dr. Zimmern gives his patients a prophylactic antibiotic before the procedure even if the urine is clear.
Bleeding is another risk during fulguration. This typically goes away with irrigation, but there is a risk of this becoming more challenging. For example, with patients taking anticoagulation medication or requiring more extensive fulguration.
Some people may get more infections for a while. During the process of opening up deep-seated infection sites, it is thought that some bacteria may be liberated into other areas of the bladder. To combat this risk, a low dose prophylactic antibiotic may be prescribed for 4-6 weeks after fulguration. The choice of antibiotic would depend on the individual’s culture and antibiotic sensitivities. Most people will be able to stop taking this antibiotic after the procedure. A small number of people may find that their symptoms return, in which case Dr. Zimmern recommends they continue taking the antibiotic for a little while longer.
For recovery following fulguration, Dr. Zimmern recommends AZO (pyridium) as local pain relief. He advises against drinking gallons of water in an attempt to flush everything through the bladder. This is not necessary and will likely just cause more pain and/or discomfort. Similarly, people should be able to eat what they normally would, only needing to avoid foods that personally cause irritation.
Typically, the first 6-12 weeks post-fulguration consist of ups and downs. During the first week in particular, it is recommended to take extra care, avoiding obligations such as travel and work if possible. Dr. Zimmern explains that it is difficult to predict exactly how long recovery will take because you can’t see exactly how deep-rooted the issue is during the fulguration procedure. However, Dr. Zimmern shares the positive news that most people will experience the benefits of fulguration forever. Once the fulgurated site has healed, it has healed.
Finally, Dr. Zimmern discusses the costs involved in fulguration. The procedure is often covered by insurance providers, but exact costs will vary on an individual basis. Dr. Zimmern welcomes fulguration patients from abroad, usually recommending that they stay in the US for 7-10 days post-procedure to allow time for any necessary follow-up.
About Dr. Zimmern
Philippe Zimmern, M.D., is a Professor of Urology at UT Southwestern Medical Center and the recipient of the Felecia & John Cain Distinguished Chair for Women’s Health in Urology. His expertise covers urinary incontinence, prolapse, and UTI.
After two Urology trainings and a fellowship at UCLA, Dr. Zimmern joined the faculty at UT Southwestern in 1995. He is a past President of the Society for Urodynamics and Female Urology. Dr. Zimmern co-directs a two-year endowed fellowship program in female pelvic medicine and reconstructive surgery. He has been a visiting professor in many countries, co-authored nearly 400 publications, 29 surgical movies, and 67 book chapters, and co-edited four textbooks on FPMRS topics. He is FPMRS certified and a member of FACS. He received the inaugural Leaders in Excellence Award at UT Southwestern (2019).
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