CPT® Code 55882

1. Indications

The procedure described by CPT® Code 55882 is indicated for the treatment of malignant prostate tissue. It is specifically utilized in cases where there is a need to ablate cancerous cells within the prostate gland, providing a minimally invasive option for patients diagnosed with prostate cancer.

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

2. Procedure

The procedure begins with the patient being anesthetized to ensure comfort throughout the intervention. A suprapubic catheter is then inserted into the anterior pelvis to facilitate urine drainage. The patient is positioned within the MRI scanner, which is essential for real-time imaging during the procedure. An endorectal cooling device, equipped with a balloon, is placed into the rectum to protect surrounding tissues from thermal damage during the ablation process. Additionally, a Foley catheter is inserted to manage bladder function.

• Step 1: The bladder is emptied and partially filled with sterile fluid to prepare for the procedure. A guidewire is advanced through the catheter, which is subsequently removed over the wire.
• Step 2: Lidocaine gel is applied to the urethra to minimize discomfort during the insertion of the TULSA transducer. The transducer is then inserted over the guidewire, with its tip positioned within the bladder.
• Step 3: After the guidewire is removed, the transducer is secured within the MRI-compatible robotic system and tested to ensure proper functionality.
• Step 4: 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.
• Step 5: The physician may manually adjust the positioning and angulation of the ultrasound applicator, as well as the lubrication and balloon volume of the cooling device, to optimize the treatment setup.
• Step 6: Treatment images are obtained and sent to the planning software workstation, where a detailed treatment plan is generated to avoid damage to nearby critical tissues.
• Step 7: Using the MRI-compatible robotic positioning system, the physician advances the ablation transducer, determining the direction and rotational angle of the ultrasound applicator to ablate the prescribed volume of target tissue within the treatment zone.
• Step 8: An anti-spasmodic drug is administered to the patient, and the ablation process begins. The transducer emits ultrasound energy while rotating to achieve optimal ablative temperature.
• Step 9: Continuous MRI images are acquired and displayed, allowing the physician to monitor the delivery of ablative energy. If any positional adjustments are necessary, the treatment is paused, and the tissues are allowed to cool before resuming with a new set of MRI images and treatment planning.
• Step 10: After the ablation is completed, contrast-enhanced images are acquired immediately to confirm satisfactory ablation of the target tissue.
• Step 11: Finally, the physician returns to the patient care area, and all devices used during the procedure are removed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications or side effects resulting from the ablation. Patients may experience some discomfort or urinary symptoms following the procedure, which should be managed appropriately. The physician will provide specific instructions regarding recovery, including any necessary follow-up appointments to assess the effectiveness of the treatment and monitor for any potential recurrence of prostate cancer. It is essential for patients to adhere to post-procedure guidelines to ensure optimal recovery and outcomes.