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Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff

CPT4 code

Name of the Procedure:

Insertion of Inflatable Urethral/Bladder Neck Sphincter

Summary

This procedure involves surgically placing an artificial sphincter system to help control urine flow in individuals with urinary incontinence. The system includes a cuff around the urethra or bladder neck, a pump in the scrotum or labia, and a reservoir in the abdomen.

Purpose

The procedure addresses urinary incontinence, often due to a weakened or damaged urethral sphincter. The goal is to restore control over urine flow, improving the patient's quality of life.

Indications

  • Severe urinary incontinence not responsive to other treatments.
  • Patients with intrinsic sphincter deficiency.
  • Prior unsuccessful surgical treatments for incontinence.

Preparation

  • Patients may need to fast for a few hours before the procedure.
  • Medication adjustments, especially blood thinners, will be necessary.
  • Preoperative assessments, including urine tests and imaging, may be required.

Procedure Description

  • Patients receive either general or regional anesthesia.
  • A small incision is made in the perineal area to place the cuff around the urethra or bladder neck.
  • Another incision is made in the scrotum or labia to position the pump.
  • A third incision is made in the lower abdomen to place the reservoir.
  • All components are connected and tested, then incisions are closed with sutures.

Duration

The procedure typically takes 1-2 hours.

Setting

It is usually performed in a hospital or surgical center.

Personnel

  • Urologic surgeon
  • Surgical nurses
  • Anesthesiologist
  • Surgical technician

Risks and Complications

  • Infection
  • Bleeding
  • Mechanical failure of the device
  • Injury to surrounding tissues
  • Urinary retention requiring catheterization

Benefits

  • Improved control over urine flow
  • Enhanced quality of life
  • Potential for returning to normal activities

Recovery

  • Patients may stay in the hospital overnight.
  • Instructions include limited physical activity and avoiding heavy lifting for 4-6 weeks.
  • Follow-up appointments to monitor device function and incision healing.

Alternatives

  • Behavioral therapies and pelvic floor exercises
  • Medications
  • Other surgical options like sling procedures
  • Use of absorbent pads or catheters

Patient Experience

  • Mild to moderate discomfort at the incision sites.
  • Swelling and bruising initially.
  • Pain management will be provided, and symptoms typically improve within a couple of weeks.

Medical Policies and Guidelines for Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff

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