Miko24
Guru
PREOPERATIVE DIAGNOSIS: Mass within prostatic urethra
POSTOPERATIVE DIAGNOSIS: Necrotic BPH/Prostate Nodule
PROCEDURES PERFORMED: Transurethral resection of prostatic urethral lesion
FINDINGS:
1. Calcified necrotic tissue within the bladder
2. Devascularized/necrotic BPH nodule? Of the left anterior prostatic urethra
INDICATIONS: Patient with history of prostate cancer treated with brachytherapy recently had bleeding from his penis. Recent cystoscopy demonstrated a anterior prostatic urethral lesion of unclear etiology presents today for resection/biopsy
PROCEDURE DETAILS:
Patient was prepped and draped in standard sterile fashion. 20 French rigid cystoscope was navigated through the urethra into the bladder. Bladder neck was relatively fixed I was unable to fully evaluate the anterior surface of the bladder but had previously been noted to be normal. There was what appeared to be a large bladder stone sitting dependently in the trigone approximately 3 to 4 cm in diameter. I used 1000 µm laser fiber to fragment it, however it turned out to be a calcified piece of soft tissue as opposed to a typical bladder stone. This was fragmented and then removed entirely. Then returned to the prostatic urethra and there was a space-occupying lesion coming off the anterior prostatic urethra with fibrinous type tissue and some of bleeding this was biopsied and placed into a specimen cup. This point time I switched 26 French continuous-flow resectoscope with the bipolar resection loop. And with closer inspection it appeared that the right prostatic lobe and the ventral prostatic lobe were all normal in appearance. The verumontanum was uninvolved and able to be visualized. Off the left side/anterior prostatic urethra is where this lesion was originating. I then resected several pieces until I got to the base and was able to essentially push it off. Until was free-floating in the bladder when I then resected and into smaller pieces and evacuated out all of the components. This point time the prostatic urethra was completely clear. Further visualization suggest that perhaps this was just a BPH nodule that become somewhat devascularized and calcified. I fulgurated any bleeding areas removed the scope to the verumontanum. Let the pressure down there was no bleeding. It should be noted that I did not resect into any of the contour of the prostate, the only tissue I removed had become a space-occupying lesion within the prostatic urethra. Thus I think any influence on continence should be minimal to none. A 20 French three-way Foley catheter was placed into the bladder. 30 mL in the balloon. Catheter was irrigated with a Toomey syringe and there was no bleeding. Catheter was connected to straight drainage and the irrigation port was capped.
This concluded the procedure. All instrument, sponge, and needle counts were correct. The patient was woken from anesthesia and taken the the recovery room in stable condition.
My provider is stating this is 52601 - I am looking more at 52235????
POSTOPERATIVE DIAGNOSIS: Necrotic BPH/Prostate Nodule
PROCEDURES PERFORMED: Transurethral resection of prostatic urethral lesion
FINDINGS:
1. Calcified necrotic tissue within the bladder
2. Devascularized/necrotic BPH nodule? Of the left anterior prostatic urethra
INDICATIONS: Patient with history of prostate cancer treated with brachytherapy recently had bleeding from his penis. Recent cystoscopy demonstrated a anterior prostatic urethral lesion of unclear etiology presents today for resection/biopsy
PROCEDURE DETAILS:
Patient was prepped and draped in standard sterile fashion. 20 French rigid cystoscope was navigated through the urethra into the bladder. Bladder neck was relatively fixed I was unable to fully evaluate the anterior surface of the bladder but had previously been noted to be normal. There was what appeared to be a large bladder stone sitting dependently in the trigone approximately 3 to 4 cm in diameter. I used 1000 µm laser fiber to fragment it, however it turned out to be a calcified piece of soft tissue as opposed to a typical bladder stone. This was fragmented and then removed entirely. Then returned to the prostatic urethra and there was a space-occupying lesion coming off the anterior prostatic urethra with fibrinous type tissue and some of bleeding this was biopsied and placed into a specimen cup. This point time I switched 26 French continuous-flow resectoscope with the bipolar resection loop. And with closer inspection it appeared that the right prostatic lobe and the ventral prostatic lobe were all normal in appearance. The verumontanum was uninvolved and able to be visualized. Off the left side/anterior prostatic urethra is where this lesion was originating. I then resected several pieces until I got to the base and was able to essentially push it off. Until was free-floating in the bladder when I then resected and into smaller pieces and evacuated out all of the components. This point time the prostatic urethra was completely clear. Further visualization suggest that perhaps this was just a BPH nodule that become somewhat devascularized and calcified. I fulgurated any bleeding areas removed the scope to the verumontanum. Let the pressure down there was no bleeding. It should be noted that I did not resect into any of the contour of the prostate, the only tissue I removed had become a space-occupying lesion within the prostatic urethra. Thus I think any influence on continence should be minimal to none. A 20 French three-way Foley catheter was placed into the bladder. 30 mL in the balloon. Catheter was irrigated with a Toomey syringe and there was no bleeding. Catheter was connected to straight drainage and the irrigation port was capped.
This concluded the procedure. All instrument, sponge, and needle counts were correct. The patient was woken from anesthesia and taken the the recovery room in stable condition.
My provider is stating this is 52601 - I am looking more at 52235????