Transurethral resection; of postoperative bladder neck contracture
CPT4 code
Name of the Procedure:
Transurethral Resection of Postoperative Bladder Neck Contracture (TURBN)
Summary
Transurethral resection of postoperative bladder neck contracture (TURBN) is a minimally invasive surgical procedure used to treat a narrowing of the bladder neck that can occur after prostate or bladder surgery. The procedure involves using a resectoscope inserted through the urethra to remove scar tissue and widen the bladder neck.
Purpose
TURBN addresses bladder neck contracture, which can cause urinary difficulties such as straining to urinate, weak urine stream, frequent urination, and incomplete bladder emptying. The goal is to restore normal urine flow and relieve associated symptoms.
Indications
- Symptoms of bladder outlet obstruction, such as weak urine stream or straining
- Frequent urinary tract infections due to incomplete bladder emptying
- Incomplete bladder emptying confirmed by ultrasound or other diagnostic tests
- Previous bladder or prostate surgery resulting in scar tissue formation at the bladder neck
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Medication adjustments, such as stopping blood thinners, may be required.
- Preoperative tests may include urine analysis, blood tests, and imaging studies like ultrasound or cystoscopy to assess the bladder.
Procedure Description
- A resectoscope is inserted through the urethra to the bladder neck.
- The surgeon uses the resectoscope to visualize the area and remove the scar tissue causing the narrowing.
- The removal of tissue helps to widen the bladder neck, improving urine flow.
- A catheter may be placed temporarily to ensure proper urine drainage post-procedure.
Tools and Equipment: Resectoscope, surgical instruments for tissue removal
Anesthesia: General or spinal anesthesia, based on patient needs and surgeon's recommendation
Duration
The procedure typically takes about 30 to 90 minutes, depending on the complexity of the case.
Setting
TURBN is performed in a hospital's operating room or a specialized outpatient surgical center.
Personnel
- Urologic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Bleeding
- Infection
- Injury to the bladder or urethra
- Urinary incontinence
- Recurrence of the contracture
- Need for repeat surgery
Benefits
- Improved urine flow and relief of urinary symptoms
- Reduced risk of urinary tract infections
- Enhanced quality of life due to better urinary function
- Most benefits are realized shortly after recovery from the procedure.
Recovery
- Patients may need to stay in the hospital for a short period post-procedure for monitoring.
- A temporary catheter may be used for a few days.
- Pain and discomfort can be managed with medications.
- Full recovery typically takes a few weeks, with limitations on strenuous activities.
- Follow-up appointments are necessary to monitor healing and ensure the success of the surgery.
Alternatives
- Urethral dilation: temporary relief by stretching the urethra
- Laser treatment: less invasive but may not be as effective for severe cases
- Open surgical reconstruction: more invasive but may be necessary for recurrent or severe contractures
Patient Experience
During the procedure, patients are under anesthesia and will not feel any pain. Postoperatively, there may be some discomfort and the sensation of needing to urinate frequently while the catheter is in place. Pain can be managed with prescribed medications. Most patients experience significant symptomatic relief within weeks, but individual experiences may vary.