CPT® Code 0550T

Deleted

1. Indications

The transperineal periurethral balloon continence device is indicated for use in men who experience urinary incontinence following prostate surgery and/or radiation therapy. This condition can arise due to the impact of these medical treatments on the pelvic floor and urinary function, necessitating interventions to restore normal urinary control and pelvic pressure.

• Urinary Incontinence This procedure is performed to manage urinary incontinence that may occur as a complication of prostate surgery or radiation therapy.

2. Procedure

The procedure for the removal of the transperineal periurethral balloon continence device involves several detailed steps to ensure safe and effective extraction. Initially, a cystoscope is introduced through the urethra into the bladder, allowing for direct visualization of the urinary tract. Following this, a sharp-tipped trocar and sheath are assembled, and a small incision is made in the perineum to facilitate access to the pelvic area. Under fluoroscopic guidance, the trocar and sheath are carefully inserted through the incision and advanced through the pelvic floor to reach the bladder. Once the trocar is positioned correctly, it is replaced with a blunt-tipped trocar to continue the advancement to the bladder level. After the trocar is removed, the deflated balloon device is advanced through the sheath to the predetermined location within the urethra. The sheath is then partially retracted, and the balloon is inflated with a small volume of fluid to secure it in place. After inflation, the sheath is removed, and the perineum is closed to complete the initial placement. If bilateral placement is required, the entire procedure is repeated on the opposite side. Following a recovery period, adjustments to the balloon volume can be made by accessing the device with a needle through the perineum, allowing for the addition of fluid until the optimal inflation volume is achieved. When the time comes for removal, a small incision is again made in the perineum, the balloon is deflated, and the device is carefully dissected free from surrounding tissue before being removed.

• Cystoscope Insertion A cystoscope is passed through the urethra into the bladder for visualization.
• Incision Creation A small incision is made in the perineum to access the pelvic floor.
• Trocar and Sheath Insertion Under fluoroscopic guidance, a sharp-tipped trocar and sheath are inserted through the incision and advanced to the bladder.
• Trocar Replacement The sharp-tipped trocar is replaced with a blunt-tipped trocar for continued advancement.
• Balloon Device Advancement The deflated balloon device is advanced through the sheath to the desired location.
• Balloon Inflation The sheath is partially retracted, and the balloon is inflated with fluid to anchor it in place.
• Sheath Removal The sheath is removed, and the perineum is closed.
• Bilateral Placement If necessary, the procedure is repeated on the opposite side.
• Volume Adjustment After recovery, fluid can be added through a needle access point to adjust balloon volume.
• Device Removal To remove the device, a small incision is made, the balloon is deflated, and the device is dissected free and removed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications following the removal of the transperineal periurethral balloon continence device. Patients may experience some discomfort at the incision site, which should be managed appropriately. It is essential to provide instructions regarding signs of infection or unusual symptoms that may require medical attention. Recovery time may vary, but patients are generally advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess recovery and ensure that urinary function is returning to normal.