Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of prostate
CPT4 code
Name of the Procedure:
Anesthesia for Transurethral Procedures (Including Urethrocystoscopy); Transurethral Resection of the Prostate (TURP)
Summary
Transurethral resection of the prostate (TURP) is a surgical procedure to treat urinary problems due to an enlarged prostate. Anesthesia is administered to ensure the patient is either unconscious or feels no pain during the procedure.
Purpose
This procedure addresses urinary issues caused by an enlarged prostate, including difficulty in urination, frequent urination, urgency, and incomplete bladder emptying. The goal is to relieve these symptoms by removing part of the prostate tissue.
Indications
- Difficulty in starting urination
- Weak urine stream
- Frequent or urgent need to urinate
- Incomplete bladder emptying
- Recurrent urinary tract infections Patients with benign prostatic hyperplasia (BPH) who do not respond to medication are typically considered for TURP.
Preparation
- Patients are usually required to fast for at least 8 hours before the procedure.
- Blood tests, urine tests, and a full physical examination are typically conducted beforehand.
- Medications may need to be adjusted or stopped based on doctor's advice.
Procedure Description
- Pre-Anesthesia: The anesthesiologist administers either general or spinal anesthesia. General anesthesia keeps the patient unconscious, while spinal anesthesia numbs from the waist down.
- Accessing the Prostate: A resectoscope is inserted through the urethra to reach the prostate.
- Resection: Small pieces of prostate tissue are shaved away using an electrical loop attached to the resectoscope.
- Completion: The resectoscope is removed, and temporary drainage (a catheter) may be inserted to help urine flow post-operation.
Duration
The TURP procedure typically takes around 60 to 90 minutes.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Urologist (Surgeon)
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Bleeding
- Infection
- Urinary incontinence
- Erectile dysfunction
- Retrograde ejaculation (semen entering the bladder instead of exiting the penis)
- Urethral stricture
Benefits
The primary benefits include significant relief from urinary symptoms and improvement in the quality of life. Symptom relief is usually noticeable within several days to a few weeks after the procedure.
Recovery
- Hospital stay: 1 to 2 days
- Temporary catheter use: Typically required for several days post-procedure
- Activity restrictions: Avoid heavy lifting and strenuous activities for a few weeks
- Follow-up: Scheduled appointments to monitor recovery and remove the catheter
Alternatives
- Medication: Alpha-blockers and 5-alpha-reductase inhibitors
- Minimally invasive treatments: Urolift, Rezum
- Open or laparoscopic surgery for severe cases Each alternative has its own pros and cons, ranging from less invasive to more effective but with a higher risk of complications.
Patient Experience
During the procedure, patients won't feel any pain due to anesthesia. Post-procedure, patients might experience mild discomfort, blood in the urine, or urinary urgency, which typically subside over time. Pain management is provided as needed to ensure comfort during the recovery period.