52649 Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are inc

Name of the Procedure:

Laser Enucleation of the Prostate (LEP) with Morcellation, including Control of Postoperative Bleeding

Summary

Laser Enucleation of the Prostate (LEP) with Morcellation is a minimally invasive surgical procedure that involves removing excess prostate tissue using a high-powered laser. This technique helps reduce urinary problems caused by an enlarged prostate. The removed tissue is then fragmented into smaller pieces (morcellation) and extracted from the body.

Purpose

LEP with Morcellation addresses urinary issues related to benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. The goals are to improve urine flow, reduce urinary retention, and alleviate symptoms such as frequent urination, difficulty starting urination, and incomplete bladder emptying.

Indications

• Difficulty urinating (straining or weak stream)
• Frequent urination, especially at night (nocturia)
• Urinary retention or incomplete bladder emptying
• Recurrent urinary tract infections

• Bladder stones due to BPH

  Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, such as stopping blood thinners, may be required.
• Preoperative assessments include urine tests, blood tests, and imaging studies like ultrasound or MRI.

Procedure Description

1. The patient is given general or spinal anesthesia to ensure comfort and pain-free experience.
2. A cystourethroscope is inserted into the urethra to provide visual access to the prostate.
3. A high-powered laser is used to carefully enucleate (separate and remove) the enlarged prostate tissue.
4. The excised tissue is morcellated, or chopped into smaller pieces, to facilitate its removal through the urethra.
5. Measures are taken to control any postoperative bleeding.
6. Additional procedures such as vasectomy, meatotomy, cystourethroscopy, urethral calibration, internal urethrotomy, and transurethral resection may be performed if necessary.

Duration

The procedure typically takes 1.5 to 2 hours.

Setting

LEP with Morcellation is usually performed in a hospital or a specialized surgical center.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Bleeding and infection
• Urinary incontinence
• Erectile dysfunction
• Urethral stricture (narrowing)
• Potential need for additional surgery

Benefits

• Significantly improved urinary flow
• Alleviation of urinary symptoms
• Reduced risk of urinary retention and recurrent infections
• Short recovery time with most patients experiencing symptom relief within a few weeks

Recovery

• Patients may need to stay in the hospital for a day or two postoperatively.
• A urinary catheter may be placed temporarily.
• Avoid heavy lifting, strenuous activities, and sexual activity for several weeks.
• Follow-up appointments to monitor recovery and ensure no complications.

Alternatives

• Medications such as alpha-blockers and 5-alpha reductase inhibitors
• Transurethral resection of the prostate (TURP)
• Urolift system
• Open prostatectomy
• Microwave thermotherapy

Each alternative has different benefits and risks. Medications can be less invasive but may not be as effective long-term. Surgical options vary in invasiveness and recovery time.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Postoperatively, patients might experience mild discomfort, a burning sensation during urination, and some blood in the urine, which typically subsides in a few days. Pain management may include prescribed medications and ample rest.