CPT® Code 0867T

Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume greater or equal to 50 mL

Transperineal laser ablation (TPLA) is a medical procedure designed to treat benign prostatic hyperplasia (BPH), a condition characterized by the enlargement of the prostate gland that can lead to lower urinary tract symptoms in men. This minimally invasive technique utilizes targeted laser energy to thermally destroy hyperplastic prostate tissue while preserving the surrounding healthy glandular tissue. The procedure is performed on an outpatient basis, which means that patients can typically return home the same day, and it is associated with a lower risk of side effects compared to more invasive surgical options. TPLA can be repeated if necessary, making it a flexible treatment option for managing BPH. During the procedure, the laser energy is absorbed by the prostate tissue, generating heat that induces necrosis of the targeted tissue within a matter of seconds. The effectiveness of the laser treatment is influenced by several factors, including the temperature, duration of heat transfer, and the depth of light distribution, which are determined by the specific wavelength of the laser used. To facilitate the procedure, a Foley catheter is placed to ensure proper drainage of urine. An ultrasound probe is typically inserted into the rectum to provide imaging guidance, and the procedure is generally performed under intravenous sedation combined with local anesthetic to enhance patient comfort. A percutaneous catheter is inserted through the perineum to deliver an optical fiber equipped with a diffusing tip and a diode laser, which is surrounded by a cooling system connected to a flow circuit of sterile saline at room temperature. Using contrast-enhanced ultrasonography or MRI-fused images, the physician positions two to four laser fibers bilaterally in the transition zone of the prostate, parallel to the urethra, utilizing a needle guiding system. Once the fibers are correctly positioned, the needle is retracted to expose the fiber tips to the targeted tissue. If a medial lobe is present, a needle and laser fiber may also be placed there. The laser is initially activated at a lower power level to confirm proper placement before the full treatment begins. Depending on the prostate's volume, the fiber may be retracted along its pathway to provide additional treatment. Throughout the procedure, real-time monitoring of tissue necrosis and temperature around the treatment area is conducted to ensure safety, with the system automatically terminating laser delivery if critical temperature limits are reached. After the procedure, the Foley catheter is removed, and the patient is monitored before discharge.