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Learn about Transurethral resection of Prostate (TURP)

TURP stands for Transurethral resection of prostate


The CPT code are as follow

52601: Electrosurgical resection of the prostate

It includes

  • Control of postoperative bleeding

  • Complete vasectomy

  • Comeplete meatotomy

  • Urethral Dilation 

  • Internal Urethrotomy


Other term and technique use for 52601.

  • Plasma button vaporization of prostate

  • Bipolar Vaporization

  • Electrovaporization


The cutting instrument used are resectoscope.

Question : If part of prostate are removed using above technique , but physician plan the procedure as in two stage, then how to report ?

Report the first day of service with 52601

Report the subsequent day of service within global days with 52601 with 58 modifier.

52630: Transurethral resection; Residual or regrowth of obstructive prostate tissue

It includes

  • Control of postoperative bleeding

  • Complete vasectomy

  • Comeplete meatotomy

  • Urethral Dilation 

  • Internal Urethrotomy


This code will be used if patient has already prostatectomy 52601 performed but now there is regrowth of prostate tissue or there is residual of prostate left.


52648 : Laser vaporization of the prostate

Includes

  • Control of postoperative bleeding

  • Complete vasectomy

  • Comeplete meatotomy

  • Urethral Dilation

  • Internal Urethrotomy


In this laser are used to resect the prostate.


52649 : Laser Enucleation of Prostate with morcellation

Includes

Control of postoperative bleeding

Complete vasectomy

Comeplete meatotomy

Urethral Dilation

Internal Urethrotomy


Enculeation of Prosate means the prostate is remove from inside while leaving hte outer capsule intact.

Morcellation means after seperating the prostate from capsule , it converted to smaller fragement using morcellator tool to remove it safely through urethra.


Practive Live Chart for above Procedure :


Chart 1

Preoperative Diagnosis: Bladder outlet obstruction due to benign prostatic enlargement.

Postoperative Diagnosis: Same as preoperative diagnosis.


Procedure Performed: Cystourethroscopy with Transurethral Resection of the Prostate (TURP) using electrosurgical resection


Description of the procedure: The patient was brought to the operating theatre and placed in the lithotomy position after administration of adequate spinal/general anesthesia. The perineal and genital regions were cleaned with antiseptic solution and draped in a sterile manner. After confirming proper positioning and sterile precautions, cystourethroscopy was performed by introducing a cystoscope gently through the urethral meatus. The penile, bulbar, and membranous urethra were carefully examined and found to be normal. The cystoscope was advanced into the bladder where systematic examination of the bladder mucosa, trigone, ureteric orifices, and bladder neck was carried out. No evidence of bladder calculi, tumor, or mucosal abnormality was noted.


The cystoscope was then withdrawn and replaced with a resectoscope fitted with an electrosurgical cutting loop. Continuous irrigation was established to maintain adequate visualization. On endoscopic examination, enlargement of the prostate gland with obstruction of the prostatic urethra was observed. Electrosurgical resection of the prostate was then initiated. Initial grooves were created at approximately the 5 o’clock and 7 o’clock positions extending from the bladder neck up to the level of the verumontanum. The median lobe, when present, was resected first followed by systematic resection of the right and left lateral lobes. Prostatic tissue was resected in small chips using controlled strokes of the electrosurgical loop while maintaining continuous irrigation for clear visualization. Care was taken throughout the procedure to avoid injury to the verumontanum and the external urinary sphincter.


Resection continued until an adequate prostatic channel was created and the bladder neck was clearly visualized. Hemostasis was achieved by coagulating bleeding points using the coagulation current of the electrosurgical unit. The resected prostatic tissue fragments were evacuated from the bladder using an evacuator device through the resectoscope sheath. A final cystoscopic inspection confirmed satisfactory hemostasis, adequate removal of obstructing prostatic tissue, and normal appearance of the bladder mucosa and ureteric orifices.


Following completion of the procedure, a three-way Foley catheter was inserted into the bladder. Continuous bladder irrigation with sterile irrigating solution was initiated to prevent clot formation and maintain catheter patency. The resected prostatic tissue chips were collected and sent for histopathological examination.


The procedure was completed without complications. Estimated blood loss was minimal to moderate. The patient tolerated the procedure well and was shifted to the recovery room in stable condition with continuous bladder irrigation in place.


Specimen: Resected prostatic tissue chips sent for histopathology.


Chart 2


Procedure Performed: Cystourethroscopy with Plasma Button Vaporization of the Prostate


Preoperative Diagnosis: Bladder outlet obstruction secondary to benign prostatic enlargement.

Postoperative Diagnosis: Same as preoperative diagnosis.


The patient was brought to the operating theatre and placed in the lithotomy position after administration of adequate spinal/general anesthesia. The genital and perineal areas were prepared with antiseptic solution and draped in a sterile fashion. After confirming proper positioning and sterile precautions, cystourethroscopy was performed by gently introducing a cystoscope through the urethral meatus. The penile urethra, bulbar urethra, and membranous urethra were inspected and appeared normal. The cystoscope was advanced into the bladder where systematic examination of the bladder mucosa, trigone, ureteric orifices, and bladder neck was carried out. No bladder calculi, tumors, or mucosal abnormalities were noted.


The cystoscope was then withdrawn and replaced with a resectoscope equipped with a plasma button electrode connected to a bipolar electrosurgical generator. Continuous irrigation with normal saline was established to maintain clear visualization throughout the procedure. Endoscopic examination revealed enlargement of the prostate gland causing narrowing of the prostatic urethra.


Plasma button vaporization of the prostate was then performed. Vaporization was started at the bladder neck and carried out in a systematic manner. The plasma button electrode was applied to the surface of the prostatic tissue, generating a plasma field that allowed controlled vaporization of the obstructing prostatic tissue. The median lobe, when present, was vaporized first, followed by sequential vaporization of the right and left lateral lobes. The electrode was moved in sweeping motions to gradually vaporize the prostatic tissue and create a wide prostatic channel. Care was taken to preserve the verumontanum and avoid injury to the external urinary sphincter.


Vaporization was continued until an adequate channel was established from the bladder neck to the level of the verumontanum, providing unobstructed urinary flow. Hemostasis was achieved simultaneously during vaporization due to the coagulative effect of the plasma energy. Any minor bleeding points were coagulated using the same electrode.


A final cystoscopic inspection was performed to confirm adequate vaporization of the prostatic tissue, satisfactory hemostasis, and intact bladder mucosa with normal ureteric orifices. Following completion of the procedure, a three-way Foley catheter was inserted into the bladder. Continuous bladder irrigation with normal saline was initiated to prevent clot formation.


The patient tolerated the procedure well without intraoperative complications and was shifted to the recovery room in stable condition.


Chart 3


Procedure Performed: Cystourethroscopy with Transurethral Resection and Plasma Button Vaporization of the Prostate


Preoperative Diagnosis: Recurrent bladder outlet obstruction due to regrowth of prostatic tissue following previous transurethral resection of the prostate.


Postoperative Diagnosis: Obstructing anterior and posterior prostatic lobe tissue causing interruption of urinary flow.


The patient was brought to the operating theatre and placed in the lithotomy position after administration of adequate spinal/general anesthesia. The genital and perineal areas were prepared with antiseptic solution and draped in a sterile fashion. Following standard surgical time-out and sterile precautions, cystourethroscopy was performed by introducing a cystoscope through the urethral meatus. The penile, bulbar, and membranous urethra were inspected and found to be normal. The cystoscope was advanced into the bladder where a systematic examination of the bladder mucosa, trigone, ureteric orifices, and bladder neck was performed. The bladder appeared normal without evidence of stones or tumors.


Endoscopic evaluation of the prostatic urethra revealed residual and regrown prostatic tissue despite the patient having undergone previous transurethral resection of the prostate several years earlier. Prominent obstructing tissue was noted involving the anterior and posterior lobes of the prostate, resulting in narrowing of the prostatic urethral channel and interruption of urinary flow.


The cystoscope was withdrawn and replaced with a resectoscope fitted with a plasma button electrode connected to a bipolar electrosurgical generator. Continuous irrigation with normal saline was established to maintain clear visualization. Plasma button vaporization and resection of the obstructing prostatic tissue were performed. The obstructing anterior lobe tissue was first vaporized carefully using controlled sweeping movements of the plasma button electrode. Subsequently, the posterior lobe tissue was vaporized and resected to widen the prostatic urethral channel.


The procedure was carried out systematically from the bladder neck toward the level of the verumontanum. Care was taken throughout the procedure to avoid injury to the verumontanum and the external urinary sphincter. The plasma energy allowed simultaneous vaporization and coagulation, resulting in good hemostasis. Additional coagulation was performed where necessary to control minor bleeding points.


Vaporization and limited resection were continued until a wide and unobstructed prostatic channel was created. A final cystoscopic inspection confirmed adequate removal of obstructing tissue and satisfactory hemostasis. The bladder mucosa and ureteric orifices were again visualized and appeared normal.


At the completion of the procedure, a three-way Foley catheter was inserted into the bladder and continuous bladder irrigation with normal saline was initiated to prevent clot formation. The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.


Chart 4


Procedure Performed: Cystourethroscopy with Transurethral Laser Vaporization of the Prostate (GreenLight Laser)


Preoperative Diagnosis: Bladder outlet obstruction secondary to benign prostatic enlargement.

Postoperative Diagnosis: Same as preoperative diagnosis.


The patient was brought to the operating theatre and placed in the lithotomy position following administration of adequate spinal or general anesthesia. The genital and perineal areas were prepared with antiseptic solution and draped in a sterile fashion. After completion of the surgical time-out, cystourethroscopy was performed by introducing a cystoscope through the urethral meatus. The penile urethra, bulbar urethra, and membranous urethra were inspected and found to be normal. The cystoscope was advanced into the bladder and a systematic examination of the bladder mucosa, trigone, ureteric orifices, and bladder neck was carried out. No bladder stones, tumors, or mucosal abnormalities were identified.


The cystoscope was then replaced with a laser resectoscope. Continuous irrigation was established to maintain clear endoscopic visualization. On evaluation, enlargement of the prostate with obstruction of the prostatic urethra was noted.


A GreenLight laser fiber was introduced through the working channel of the resectoscope. Laser vaporization of the prostatic tissue was then performed in a systematic manner. Vaporization was initiated at the bladder neck and carried distally toward the level of the verumontanum. The laser fiber was applied in controlled sweeping movements to vaporize the obstructing prostatic tissue while maintaining adequate visualization. The vaporization was continued down to near the surgical capsule in the standard fashion to create an adequate prostatic channel.


Both lateral lobes were treated sequentially with careful attention to maintain orientation and preserve the verumontanum and external urinary sphincter. The laser energy provided effective tissue vaporization with simultaneous coagulation, resulting in excellent hemostasis throughout the procedure.


Following completion of vaporization, the prostatic urethral channel was widely patent. A final cystoscopic inspection confirmed adequate vaporization of obstructing prostatic tissue and satisfactory hemostasis. The bladder mucosa and ureteric orifices were visualized and appeared normal.


At the completion of the procedure, a Foley catheter was inserted into the bladder and bladder irrigation was initiated as required. The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.


Estimated Blood Loss: Minimal


Chart 5


Procedure Performed: Cystourethroscopy with Laser Enucleation of the Prostate (HoLEP) and Morcellation


Preoperative Diagnosis: Bladder outlet obstruction due to benign prostatic enlargement.

Postoperative Diagnosis: Same as preoperative diagnosis.


Description :

The patient was brought to the operating theatre and placed in the lithotomy position after administration of adequate spinal or general anesthesia. The genital and perineal areas were prepared with antiseptic solution and draped in a sterile fashion. After completing the surgical time-out, cystourethroscopy was performed by introducing a cystoscope through the urethral meatus. The penile, bulbar, and membranous urethra were inspected and found to be normal. The cystoscope was advanced into the bladder for systematic inspection of the bladder mucosa, trigone, ureteric orifices, and bladder neck. No bladder stones, tumors, or mucosal abnormalities were observed.

A laser resectoscope equipped with a Holmium/GreenLight laser fiber was then introduced. Continuous irrigation with normal saline was established for optimal visualization. Laser enucleation of the prostate was initiated at the bladder neck, with a controlled incision extending along the surgical plane down to the bladder neck fiber. The adenomatous prostatic tissue was carefully swept off the prostate capsule on the right and left sides, maintaining the dissection plane between the adenoma and the surgical capsule. The entire adenoma was enucleated en bloc, except for a small portion at the bladder neck which was left for subsequent morcellation.

Following complete enucleation, a bipolar resectoscope morcellator was introduced into the bladder. The enucleated prostate tissue was morcellated into small fragments and evacuated from the bladder under continuous irrigation. Hemostasis was achieved throughout the procedure, and careful attention was given to avoid injury to the external urinary sphincter and bladder neck.

A final cystoscopic inspection confirmed adequate enucleation, complete removal of obstructing tissue, and satisfactory hemostasis. The bladder mucosa and ureteric orifices were visualized and appeared normal. A three-way Foley catheter was inserted, and continuous bladder irrigation was initiated to prevent clot formation.

The patient tolerated the procedure well without intraoperative complications and was transferred to the recovery room in stable condition.

Estimated Blood Loss: MinimalComplications: NoneSpecimen: Enucleated prostate tissue morcellated and sent for histopathology





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