Name of the Procedure:

Cystourethroscopy with insertion of transprostatic implants; 4 or more implants

Common name(s): Prostate implant procedure, Transurethral prostate implant Technical/medical term: Cystourethroscopy with transprostatic implant insertion (HCPCS C9740)

Summary

This procedure is a minimally invasive surgical technique to treat urinary symptoms caused by an enlarged prostate. It involves using a cystourethroscope to insert implants into the prostate to lift and hold the enlarged tissue out of the way, relieving obstruction of the urethra.

Purpose

The procedure is primarily used to treat urinary symptoms and complications caused by benign prostatic hyperplasia (BPH), such as difficulty urinating, weak stream, frequent urination, and incomplete bladder emptying. The goal is to improve urinary flow and reduce related symptoms without cutting or removing prostate tissue.

Indications

• Symptoms of BPH: trouble starting urination, weak urine stream, frequent urination, urgency, and inability to empty the bladder completely.
• Failure of or intolerance to medication for BPH.
• Desire to avoid more invasive surgery.
• Patient prefers a procedure with a quicker recovery time and fewer risks of sexual side effects.

Preparation

• Patients may be asked to stop taking blood thinning medications a few days before the procedure.
• Fasting for several hours before the procedure is typically required.
• Pre-procedure tests may include urine analysis, PSA blood test, and imaging studies like ultrasound.

Procedure Description

1. The patient is positioned, and anesthesia (usually local with sedation or sometimes general) is administered.
2. A cystourethroscope is inserted through the urethra to visualize the prostate and surrounding structures.
3. Implants (numbering four or more) are inserted via a specialized delivery device through the scope and deployed into the prostate tissue.
4. The implants "lift and hold" the enlarged prostate tissue, alleviating pressure on the urethra and improving urine flow.
5. The cystoscope and device are removed, and the procedure is completed.

Duration

Typically, the procedure takes about 1 hour.

Setting

This procedure is usually performed in an outpatient surgical center or hospital.

Personnel

• Urologist or trained surgeon
• Assisting nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common risks: mild to moderate pain, blood in urine, urinary urgency, and burning during urination.
• Rare risks: infection, blood clots, implant displacement, or injury to the bladder or urethra.
• Possible complications: acute urinary retention, need for additional procedures.

Benefits

• Relief from urinary symptoms caused by BPH.
• Improvement in urine flow and bladder emptying.
• Quick recovery time compared to more invasive procedures.
• Lower risk of sexual side effects compared to traditional prostate surgeries.

Recovery

• Patients can typically go home the same day.
• Pain management may include over-the-counter pain relievers.
• Most patients can resume normal activities within a few days.
• Follow-up appointments may be scheduled to monitor progress.

Alternatives

• Medications (Alpha-blockers, 5-alpha-reductase inhibitors)
• Minimally invasive surgeries (laser therapy, transurethral needle ablation)
• Traditional surgical approaches (Transurethral resection of the prostate (TURP))

Pros & Cons: Medications have fewer immediate risks but may not be as effective. Traditional surgeries offer more permanent solutions but come with higher risks and longer recovery times.

Patient Experience

• During the procedure: Patients will be sedated or under anesthesia, so they should feel minimal discomfort.
• After the procedure: Mild pain, blood in the urine, and urinary urgency are common but typically resolve within a few days.
• Pain management: Prescribed or over-the-counter pain medications, drinking plenty of fluids.

Patients often report significant improvement in urinary symptoms within a few weeks, contributing to an enhanced quality of life.