CPT® Code 0549T

Deleted

1. Indications

The transperineal periurethral balloon continence device is indicated for use in men experiencing urinary incontinence, particularly as a result of prostate surgery and/or radiation therapy. This procedure is aimed at restoring normal pelvic pressure and urinary continence, addressing the complications that may arise from these medical interventions.

• Urinary Incontinence This procedure is performed to manage urinary incontinence in men, which can occur after prostate surgery or radiation therapy.
• Post-Surgical Complications It is indicated for patients who have undergone prostate surgery and are experiencing difficulties with urinary control.
• Radiation Therapy Effects The device is also indicated for men who have received radiation therapy and are suffering from resultant urinary incontinence.

2. Procedure

The procedure for the unilateral placement of the transperineal periurethral balloon continence device involves several critical steps to ensure proper placement and functionality of the device.

• Cystoscopy The procedure begins with the insertion of a cystoscope through the urethra into the bladder. This allows the physician to visualize the urinary tract and confirm the appropriate anatomical landmarks.
• Incision and Trocar Insertion A sharp-tipped trocar and sheath are assembled, and a small incision is made in the perineum. Under fluoroscopic guidance, the trocar and sheath are inserted through this incision and advanced through the pelvic floor.
• Advancement to the Bladder The sharp-tipped trocar is then replaced with a blunt-tipped trocar, and advancement continues until the trocar reaches the level of the bladder.
• Balloon Device Placement Once the trocar is removed, the deflated balloon device is advanced through the sheath to the desired location within the periurethral area.
• Balloon Inflation The sheath is partially retracted, and the balloon is inflated with a small amount of fluid to anchor it securely in place. This inflation is crucial for maintaining the device's position and effectiveness.
• Closure After the balloon is inflated, the sheath is removed, and the incision in the perineum is closed to complete the procedure.

3. Post-Procedure

Following the procedure, patients typically undergo a recovery period of a few weeks. During this time, the device may be accessed using a needle inserted through the perineum to add additional fluid, allowing for adjustments to the balloon volume to achieve adequate pressure. This adjustment process can be repeated multiple times until the optimal balloon inflation volume is reached. If the device needs to be removed, a small incision is made in the perineum, the balloon is deflated, and the device is carefully dissected free from surrounding tissue before removal. Proper post-procedure care and follow-up are essential to monitor the device's effectiveness and address any complications that may arise.