Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)
CPT4 code
Name of the Procedure:
Laser Vaporization of Prostate (LVP), also known as Photoselective Vaporization of the Prostate (PVP).
Summary
Laser Vaporization of the Prostate is a minimally invasive surgical procedure used to treat urinary problems caused by an enlarged prostate, a condition also known as benign prostatic hyperplasia (BPH). By utilizing a high-energy laser, the procedure removes excess prostate tissue, alleviating blockage and improving urine flow. The procedure also includes measures to control postoperative bleeding and optionally incorporates other procedures like vasectomy or cystourethroscopy if required.
Purpose
Laser Vaporization of the Prostate addresses urinary retention and difficulty caused by BPH. The goals are to improve urinary flow, reduce symptoms like frequent urination or nocturia, and ensure better bladder function. The control of postoperative bleeding is crucial for a faster and safer recovery.
Indications
- Moderate to severe symptoms of BPH.
- Frequent urination, especially at night (nocturia).
- Weak urine stream or a feeling of incomplete bladder emptying.
- Urinary tract infections due to urinary retention.
- In cases where other treatments like medication have failed.
Preparation
- Patients may need to fast for several hours before the procedure.
- Adjustments to medications, particularly blood thinners, under doctor's advice.
- Pre-procedure diagnostic tests like blood work, urine tests, and prostate-specific antigen (PSA) tests.
- An evaluation including a digital rectal exam (DRE) and possibly imaging studies like ultrasound.
Procedure Description
- The patient is given anesthesia (general or spinal) for comfort.
- A cystoscope fitted with a laser fiber is inserted through the urethra to reach the prostate.
- The laser is used to vaporize excess prostate tissue, alleviating the blockage.
- Measures to control bleeding, such as coagulation, are employed throughout the procedure.
- Additional procedures, if needed, such as vasectomy or cystourethroscopy, can be performed concurrently.
- A catheter may be placed temporarily to ensure proper urine drainage post-procedure.
Duration
The procedure typically lasts between 1 to 2 hours, depending on the complexity and additional procedures performed.
Setting
The procedure is usually performed in a hospital or specialized surgical center, often as an outpatient surgery.
Personnel
- Urologist or surgeon
- Anesthesiologist
- Nursing staff
- Surgical technicians
Risks and Complications
- Common risks: mild bleeding, urinary incontinence, urinary tract infections (UTI), and temporary difficulty urinating.
- Rare risks: severe bleeding, significant infection, and erectile dysfunction.
- Proper management strategies are in place for complications, such as antibiotics for infections or additional interventions for severe bleeding.
Benefits
- Significant improvement in urinary flow and bladder emptying.
- Reduction in BPH symptoms.
- Shorter recovery time compared to traditional prostate surgery.
- Minimal blood loss due to laser precision.
Recovery
- Patients often go home the same day or the next day.
- Temporary catheterization may be required for a day or two.
- Avoid strenuous activities and heavy lifting for a few weeks.
- Follow-up appointments to monitor progress and manage any symptoms.
Alternatives
- Medications (alpha-blockers, 5-alpha reductase inhibitors).
- Transurethral resection of the prostate (TURP).
- Open or robotic-assisted prostatectomy.
- Each alternative has its own advantages and limitations regarding invasiveness, recovery time, and effectiveness.
Patient Experience
- During the procedure: Under anesthesia, the patient will not feel pain or discomfort.
- Post-procedure: Mild discomfort or a burning sensation during urination is common and usually resolves within a few days. Pain management may include medications to alleviate any discomfort.
- Continuous follow-up and management of any side effects ensure a smooth recovery process.