Removal of inflatable urethral/bladder neck sphincter, including pump, reservoir, and cuff
CPT4 code
Name of the Procedure:
Removal of Inflatable Urethral/Bladder Neck Sphincter, including Pump, Reservoir, and Cuff
Summary
This surgical procedure involves the removal of a previously implanted artificial sphincter device, which includes the pump, reservoir, and cuff components. These devices are used to manage urinary incontinence.
Purpose
The procedure addresses complications or failures associated with artificial urinary sphincter devices. This procedure aims to alleviate symptoms of malfunctioning or infected devices and restore the patient's comfort and urinary function.
Indications
- Malfunction or mechanical failure of the artificial sphincter
- Infection of the device or surrounding tissues
- Erosion of the cuff into the urethra
- Persistent pain or other complications associated with the device
- Patient’s choice to discontinue the use due to unsatisfactory results
Preparation
- Patients are typically advised to fast for at least 8 hours before the procedure.
- Medication adjustments might be necessary, particularly with blood thinners.
- Preoperative assessments often include blood tests, imaging studies like X-rays or ultrasounds, and a physical examination.
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made to access the urethral/bladder neck sphincter and associated components.
- The surgeon carefully dissects through the tissues to locate and remove the cuff, reservoir, and pump.
- If infections are present, thorough irrigation and debridement of infected tissues are performed.
- The surgical site is then closed with sutures or staples.
- A catheter may be inserted to ensure proper urinary drainage during the initial recovery period.
Duration
The procedure typically takes about 1 to 2 hours to complete.
Setting
The procedure is performed in a hospital's surgical suite or an outpatient surgical center.
Personnel
- Urologist or specialized surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site
- Bleeding
- Injury to surrounding organs or tissues
- Anesthesia-related complications
- Persistent urinary incontinence
- Need for further surgical procedures
Benefits
- Relief from complications caused by the malfunctioning device
- Reduction of pain or discomfort
- Improved overall quality of life Expected benefits are realized shortly after recovery from surgery.
Recovery
- Patients may be required to stay in the hospital for a day or two.
- Pain management will include medications as prescribed by the doctor.
- Activity restrictions may be recommended for several weeks.
- Follow-up appointments are crucial to monitor healing and manage any complications.
Alternatives
- Conservative management with medications and pelvic floor exercises
- Other surgical interventions, such as sling procedures for urinary incontinence Each alternative has its own set of benefits and drawbacks, which should be discussed with a healthcare provider to determine the best course of action.
Patient Experience
- During the procedure, the patient will be under anesthesia and not feel any pain.
- Post-procedure, patients may experience discomfort or pain at the incision site, which can be managed with prescribed pain relievers.
- There may be some urinary incontinence immediately after the removal, which should improve with time and additional treatments if necessary.