Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when p
CPT4 code
Name of the Procedure:
Transurethral Waterjet Ablation of Prostate (TWAP), also known as Aquablation Therapy
Summary
Transurethral Waterjet Ablation of the Prostate is a minimally invasive surgical procedure used to treat an enlarged prostate. It uses high-pressure water jets, guided by ultrasound, to remove excess prostate tissue. This procedure includes control of post-operative bleeding. Other included minor procedures are vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy.
Purpose
The procedure addresses benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged, causing urinary problems. The goals are to reduce urinary symptoms, improve urine flow, and decrease bladder obstruction.
Indications
- Difficulty in urinating
- Frequent urination, especially at night
- Urgency to urinate
- Weak urine stream or stream that stops and starts
- Inability to completely empty the bladder
Patient criteria:
- Diagnosis of benign prostatic hyperplasia (BPH)
- Moderate to severe urinary symptoms affecting the quality of life
- Considered suitable for minimally invasive intervention
Preparation
- Patients may be required to fast for 6-8 hours before the procedure.
- Medication adjustments might be necessary, especially blood thinners.
- Pre-operative assessments, including blood tests, urine tests, and prostate ultrasound.
Procedure Description
- Patient is placed under general or spinal anesthesia.
- A cystoscope (a thin tube with a camera) is inserted through the urethra to visualize the prostate.
- Ultrasound guidance is used to map the prostate.
- High-pressure waterjets are directed at the prostate tissue to remove the excess parts.
- Control of post-operative bleeding is managed through direct visualization and intervention.
- Additional procedures such as vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are performed if necessary.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is performed in a hospital or surgical center, typically in an outpatient setting.
Personnel
- Urologist or urological surgeon
- Anesthesiologist
- Surgical nurses
- Ultrasound technician
Risks and Complications
Common risks:
- Bleeding
- Infection
- Temporary difficulty in urinating Rare risks:
- Injury to the urethra or bladder
- Urinary incontinence
- Erectile dysfunction Complications are generally managed with medical or surgical intervention.
Benefits
- Significant improvement in urinary symptoms
- Minimized risk of sexual dysfunction compared to traditional surgery
- Quick recovery times
- Usually, noticeable improvement within a few weeks.
Recovery
- Hospital stay of 1-2 days, or outpatient discharge in some cases
- Temporary urinary catheter may be needed for 1-3 days.
- Avoid strenuous activities for a couple of weeks.
- Follow-up appointments to monitor recovery and symptom improvement.
Alternatives
- Medication management with alpha-blockers or 5-alpha-reductase inhibitors.
- Other surgical options like Transurethral Resection of the Prostate (TURP), laser therapy. Pros and cons:
- Medications have fewer immediate risks but can be less effective in severe cases.
- TURP and laser therapy are more invasive but effective, with different risk profiles.
Patient Experience
- The procedure is typically well-tolerated under anesthesia.
- Some mild discomfort or mild pain post-procedure, managed with pain medication.
- Minimal blood in urine for up to a few days.
- Improvement in urinary symptoms is usually observed within a few weeks to months.