CPT® Code 52649

Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)

A complete laser enucleation of the prostate is a surgical procedure that utilizes laser technology to remove prostate tissue. This procedure is characterized by the morcellation process, which involves dividing the prostate into smaller fragments to facilitate easier removal. The procedure also includes the management of postoperative bleeding, ensuring that any bleeding that may occur during or after the surgery is effectively controlled. In addition to the primary enucleation, several other procedures may be performed concurrently, such as vasectomy, meatotomy, cystourethroscopy (also known as cystoscopy), urethral calibration and/or dilation, internal urethrotomy, and transurethral resection of the prostate, if deemed necessary. Before the laser enucleation begins, a cystoscopy is conducted to inspect the bladder for any tumors or abnormal masses. Following this, the urethra is calibrated and dilated using a series of instruments known as sounds, which help to prepare the urethra for the procedure. If the meatus, or the opening of the urethra, is found to be narrowed, a meatotomy may be performed to incise and widen it. The procedure employs a continuous flow resectoscope sheath, which is equipped with a laser fiber and a video system to visualize the surgical area. Normal saline is used as an irrigant to maintain a clear view during the procedure. The enucleation process involves sequentially addressing each lobe of the prostate, typically starting with the median lobe. The laser is used to create grooves and separate the lobes from surrounding tissues, ensuring that all attachments are carefully divided. Once the lobes are enucleated, they are pushed into the bladder, where a morcellator is used to cut the tissue into smaller pieces for removal. This comprehensive approach not only addresses the enlargement of the prostate but also minimizes complications and promotes effective recovery.