Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed)
CPT4 code
Name of the Procedure:
Laser Coagulation of Prostate (LCP) Common name(s): Laser Prostate Surgery Technical/Medical term: Transurethral Laser Coagulation of the Prostate (TULC)
Summary
Laser coagulation of the prostate is a minimally invasive surgical procedure that uses laser energy to coagulate and reduce prostate tissue. This helps to alleviate urinary symptoms caused by an enlarged prostate. The procedure also includes management of postoperative bleeding, and may involve other procedures such as vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy if necessary.
Purpose
Laser coagulation of the prostate is primarily performed to treat benign prostatic hyperplasia (BPH), a condition in which the prostate gland enlarges and causes urinary symptoms. The goals of the procedure are to improve urine flow, reduce urinary frequency and urgency, and provide long-term relief from BPH symptoms.
Indications
- Difficulty in urinating or weak urine stream
- Frequent urination, especially at night (nocturia)
- Urgency to urinate
- Incomplete bladder emptying
- Recurrent urinary tract infections
- BPH unresponsive to medication or less invasive treatments
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Blood tests, urine tests, and imaging studies such as an ultrasound may be conducted beforehand.
- Certain medications, particularly blood thinners, may need to be adjusted or temporarily discontinued.
Procedure Description
- The patient is given anesthesia; either general or spinal anesthesia may be used.
- The surgeon inserts a cystoscope through the urethra to reach the prostate.
- Laser energy is applied to the prostate tissue to coagulate and reduce its size.
- Additional procedures such as vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, or internal urethrotomy may be performed if needed.
- Measures are taken to control postoperative bleeding.
- The cystoscope is removed, and a temporary catheter may be placed to aid in urination during the initial recovery period.
Duration
The procedure typically takes about 1 to 2 hours, depending on the extent of the surgery and any additional procedures performed.
Setting
Laser coagulation of the prostate is usually performed in a hospital operating room or an outpatient surgical center.
Personnel
- Urologist or surgeon specializing in prostate surgery
- Anesthesiologist
- Surgical nurses
- Support staff
Risks and Complications
- Bleeding during or after the procedure
- Infection
- Pain or discomfort
- Temporary difficulty urinating or urinary retention
- Retrograde ejaculation (semen enters the bladder instead of exiting through the penis)
- Rarely, erectile dysfunction
Benefits
- Relief from urinary symptoms related to BPH
- Improved urine flow
- Minimal scarring due to the precision of the laser technique
- Quick recovery time compared to traditional surgery
- Long-term reduction of prostate size and symptoms
Recovery
- Patients may go home the same day or stay overnight, depending on their condition.
- A catheter may remain in place for a few days to a week.
- Pain management and antibiotic medications may be prescribed.
- Avoid strenuous activities for several weeks and follow all post-operative instructions.
- Follow-up appointments are necessary to monitor recovery and prostate health.
Alternatives
- Medication such as alpha-blockers or 5-alpha-reductase inhibitors
- Minimally invasive treatments like transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA)
- Traditional surgery like transurethral resection of the prostate (TURP)
- Watchful waiting for mild symptoms
Patient Experience
During the procedure, the patient will be under anesthesia and will not feel any discomfort. Postoperatively, there may be mild pain, burning sensations during urination, and some blood in the urine. These symptoms typically subside within a few days to weeks. Pain management strategies and comfort measures, such as taking prescribed pain medication and using a warm compress, will help ease discomfort during recovery.