How would you code for a transperineal biopsy of a possible prostate cancer recurrence post radical prostatectomy?
POSTOPERATIVE DIAGNOSIS: History of prostate cancer with questionable
recurrence at an anastomosis (post radical prostatectomy in 1996)
PROCEDURE PERFORMED: Cystoscopy and transperineal fusion/targeted
biopsy of anastomotic mass.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR PROCEDURE: Patient with an elevated PSA and positive
PSA on scan for a lesion at the anastomosis. After discussion with him, he agreed to proceed with
transperineal targeted fusion biopsy of this area. The patient's case was complicated by him having an
artificial sphincter.
DETAILS OF PROCEDURE: The patient was brought to the operating room; and after general
anesthesia was instituted by the anesthesiologist, the patient was put in the dorsal lithotomy position and
prepped and draped in the usual sterile fashion. A time-out was taken. The sphincter was deactivated
and I tried to place both the 14-French and 14 Coude catheter was unsuccessful and met resistant. So
then, I used a flexible cystoscope into my way into the bladder and no erosion of the sphincter was seen.
No significant urethral trauma was seen. A wire was placed and a hole puncture then utilized and the
catheter to create a council-tip catheter and a 14-French catheter was advanced. The wire was removed.
The balloon was inflated to 10 cc of sterile water. It was clamped and the scrotum was prepped out the
way. Then, the transrectal ultrasound probe was placed by the radiology technologist. We were able to
fuse the image obtaining MRI onto the ultrasound. We were able to take four cores from the area in
question and closed attention trying as best we can stay away from the sphincter after this was completed.
The ultrasound probe was removed. The catheter was deflated and removed.
POSTOPERATIVE DIAGNOSIS: History of prostate cancer with questionable
recurrence at an anastomosis (post radical prostatectomy in 1996)
PROCEDURE PERFORMED: Cystoscopy and transperineal fusion/targeted
biopsy of anastomotic mass.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR PROCEDURE: Patient with an elevated PSA and positive
PSA on scan for a lesion at the anastomosis. After discussion with him, he agreed to proceed with
transperineal targeted fusion biopsy of this area. The patient's case was complicated by him having an
artificial sphincter.
DETAILS OF PROCEDURE: The patient was brought to the operating room; and after general
anesthesia was instituted by the anesthesiologist, the patient was put in the dorsal lithotomy position and
prepped and draped in the usual sterile fashion. A time-out was taken. The sphincter was deactivated
and I tried to place both the 14-French and 14 Coude catheter was unsuccessful and met resistant. So
then, I used a flexible cystoscope into my way into the bladder and no erosion of the sphincter was seen.
No significant urethral trauma was seen. A wire was placed and a hole puncture then utilized and the
catheter to create a council-tip catheter and a 14-French catheter was advanced. The wire was removed.
The balloon was inflated to 10 cc of sterile water. It was clamped and the scrotum was prepped out the
way. Then, the transrectal ultrasound probe was placed by the radiology technologist. We were able to
fuse the image obtaining MRI onto the ultrasound. We were able to take four cores from the area in
question and closed attention trying as best we can stay away from the sphincter after this was completed.
The ultrasound probe was removed. The catheter was deflated and removed.