Name of the Procedure:

Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant

Summary

Cystourethroscopy with insertion of a permanent adjustable transprostatic implant is a minimally invasive procedure used to alleviate urinary symptoms due to an enlarged prostate. It involves using a scope to visualize the urinary tract and placing an implant to widen the urethra, thus improving urine flow.

Purpose

This procedure addresses benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. The goal is to reduce urinary symptoms such as difficulty starting urination, weak urine stream, and frequent urination, thereby improving the patient's quality of life.

Indications

• Symptoms of bladder outlet obstruction due to BPH
• Incomplete bladder emptying
• Frequent urinary tract infections related to BPH
• Poor response to medical therapy for BPH

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications, such as blood thinners, might need to be adjusted.
• Pre-procedure diagnostic tests could include urinary flow studies, ultrasound, or prostate-specific antigen (PSA) blood tests.

Procedure Description

1. The patient is positioned, and anesthesia (typically local or general) is administered.
2. A cystoscope (a thin, flexible tube with a camera) is inserted through the urethra to view the bladder and prostate area.
3. An implant device is then inserted through the cystoscope to the prostate, where it is adjusted to hold open the urethra.
4. Once the implant is properly positioned, the instruments are removed, and the procedure is completed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is generally performed in a hospital or outpatient surgical center.

Personnel

• Urologist (surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurses or assistants

Risks and Complications

• Common risks: Temporary urinary retention, mild discomfort during urination, blood in the urine.
• Rare risks: Infection, implant displacement, damage to the urethra or bladder, and allergic reactions to anesthesia.

Benefits

• Improved urinary flow and reduction in BPH symptoms.
• Minimally invasive with a quick recovery time.
• Immediate symptom relief in many cases.

Recovery

• Patients may go home the same day.
• Pain or discomfort can generally be managed with over-the-counter pain relievers.
• Avoid heavy lifting and strenuous activity for a few days.
• Follow-up appointments to monitor implant position and urinary function.

Alternatives

• Medication (alpha-blockers, 5-alpha-reductase inhibitors)
• Other minimally invasive procedures (e.g., transurethral microwave therapy, laser therapy)
• Surgical options (e.g., transurethral resection of the prostate (TURP), open prostatectomy)

Pros of alternatives: Varying degrees of effectiveness, invasiveness, and side-effect profiles. Cons of alternatives: Some might involve longer recovery times, higher complication rates, or the need for repeated treatments.

Patient Experience

During the procedure: Patients may feel some pressure or mild discomfort if under local anesthesia. After the procedure: Normal to experience mild burning during urination and some blood in the urine. Pain management: Over-the-counter pain relievers are typically sufficient. Comfort measures: Drink plenty of fluids to help flush the bladder and follow post-procedure care instructions to ensure a smooth recovery.