CPT® Code 51721

1. Indications

The procedure described by CPT® Code 51721 is indicated for the treatment of malignant prostate tissue. It is specifically utilized in cases where thermal ablation is deemed necessary to target and destroy cancerous cells within the prostate. The use of MRI-monitored transurethral ultrasound ablation (TULSA) is particularly beneficial for patients who require precise targeting of the affected tissue while minimizing damage to surrounding structures.

• Malignant Prostate Tissue The primary indication for this procedure is the presence of malignant tissue within the prostate gland that requires ablation to manage or treat prostate cancer.

2. Procedure

The procedure begins with the patient being anesthetized and connected to monitoring equipment to ensure safety throughout the process. Following this, intravenous (IV) antibiotics and an anti-spasmodic medication are administered to prepare the patient for the procedure. A suprapubic catheter is then placed in the anterior pelvis to facilitate urinary drainage during the ablation process. The patient is positioned within the MRI scanner to allow for real-time imaging during the procedure.

• Placement of Endorectal Cooling Device An endorectal cooling device, equipped with a balloon, is inserted into the rectum to protect surrounding tissues from the heat generated during the ablation. This device is crucial for maintaining the integrity of the rectal wall and preventing thermal injury.
• Foley Catheter Insertion A Foley catheter is placed to ensure the bladder is adequately drained. The bladder is then emptied and partially filled with sterile fluid to create an optimal environment for the procedure.
• Guidewire Advancement A guidewire is advanced through the catheter, which is subsequently removed over the wire to facilitate the insertion of the TULSA transducer.
• Lidocaine Gel Application Lidocaine gel is applied to the urethra to minimize discomfort during the insertion of the transducer.
• Transducer Insertion The TULSA transducer is inserted over the guidewire, with its tip positioned within the bladder. Once in place, the guidewire is removed, and the transducer is secured within the MRI-compatible robotic system.
• Testing and Imaging The transducer is tested to ensure proper functionality, and MRI scout imaging is performed to check for any air bubbles in the rectum that could interfere with the cooling of the endorectal device. Multiplanar MRI images are then acquired to confirm the correct positioning of both the transducer and the cooling device.
• Adjustment of Devices The positioning and angulation of the ultrasound applicator, as well as the endorectal cooling device, may be manually adjusted to achieve optimal placement. This step is critical for ensuring effective ablation of the targeted tissue.
• Ablation Procedure Once satisfactory positioning is confirmed, the physician who placed the devices typically exits the area, allowing the treating physician to perform the ablation. After the ablation is completed, the initial physician returns to remove the catheters, applicators, and devices used during the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications related to the ablation. The removal of the suprapubic catheter and other devices is performed once the procedure is completed. Patients may require follow-up imaging or assessments to evaluate the effectiveness of the ablation and to monitor for any potential recurrence of prostate cancer. It is essential to provide appropriate post-operative instructions regarding activity restrictions, signs of complications, and follow-up appointments to ensure optimal recovery and management of the patient's condition.