Transurethral Resection of the Prostate (TURP)

CPT 52601
Approach Endoscopic
Add-on / Variant CPTs
  • 52450 — Transurethral incision of prostate (TUIP) — for small glands, no resection
  • 52630 — TURP, residual or regrowth
  • 52648 — Laser vaporization of prostate (GreenLight PVP/VLAP)
  • 52649 — Laser enucleation of prostate (HoLEP)
Preoperative Diagnosis:

Benign prostatic hyperplasia with lower urinary tract symptoms / urinary retention

Postoperative Diagnosis:

Same

Procedure Performed:

Transurethral resection of the prostate (TURP)

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

Spinal / general
Patient in dorsal lithotomy position. Foley catheter in place.

Indications:

Patient presents with [symptomatic BPH / urinary retention / recurrent UTIs / gross hematuria / bladder stones from BPH] refractory to [or not a candidate for] medical management. Prostate volume approximately [X] grams on TRUS/MRI. AUA symptom score [X]. Risks including retrograde ejaculation, bleeding, TUR syndrome (rare with bipolar), urethral stricture, and incontinence discussed. Consent obtained.

Findings:

Cystoscopy revealed [X]-gram appearing prostate with [lateral lobe / median lobe / trilobar] hyperplasia. Bladder mucosa [normal]. No evidence of bladder tumor. Ureteral orifices visualized bilaterally. Bladder capacity approximately [X] mL.

Description of Procedure:

The patient was placed in dorsal lithotomy position and prepped and draped in sterile fashion. A [26-French] continuous flow resectoscope with [monopolar / bipolar] electrode was introduced under direct visualization. Cystourethroscopy was performed.
Resection was initiated at the [bladder neck / median lobe] and carried systematically through the [lateral lobes], using the verumontanum as the distal resection landmark. [Bipolar resection with normal saline irrigant.] Obstructing tissue was resected in a systematic fashion. Hemostasis achieved by roller-ball coagulation. The surgical capsule was identified bilaterally confirming adequate resection.
Resected chips were evacuated with Ellik evacuator. Estimated resected tissue weight [X] grams. Final cystoscopy confirmed adequate channel, hemostasis, and intact ureteral orifices.
A [22-French] three-way Foley catheter was placed and the balloon inflated to [30-50] mL for traction hemostasis. Continuous bladder irrigation initiated. Patient tolerated the procedure well.

Complications:

None

Specimens:

Prostate chips sent to pathology

Estimated Blood Loss:

Minimal to [X] mL (intravascular irrigation losses not quantifiable)

Drains:

[22-Fr] three-way Foley catheter to continuous bladder irrigation

Disposition:

Patient was taken to PACU in stable condition. Admitted overnight for catheter irrigation.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Benign prostatic hyperplasia with [lower urinary tract symptoms / urinary retention]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Transurethral resection of the prostate (TURP), [monopolar / bipolar]
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: Spinal / general

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with symptomatic BPH [/ urinary retention / recurrent UTIs / gross hematuria] refractory to medical management. Prostate volume approximately *** grams on TRUS/MRI; AUA symptom score ***. Risks including retrograde ejaculation, bleeding, TUR syndrome (rare with bipolar), urethral stricture, and incontinence were discussed. Informed consent obtained.

FINDINGS: Cystoscopy revealed approximately *** gram prostate with [lateral lobe / median lobe / trilobar] hyperplasia. Bladder mucosa normal. No bladder tumor. Ureteral orifices visualized bilaterally.

DESCRIPTION OF PROCEDURE:
Patient placed in dorsal lithotomy position and prepped in sterile fashion. A 26-French continuous flow resectoscope with [monopolar / bipolar] electrode introduced under direct vision. Cystourethroscopy performed — bladder and ureteral orifices confirmed normal. Resection initiated at the bladder neck and median lobe, carried systematically through the lateral lobes. Verumontanum used as the distal resection landmark. [Bipolar resection with normal saline irrigant.] Obstructing tissue resected systematically; hemostasis achieved with roller-ball coagulation. Surgical capsule identified bilaterally confirming adequate resection. Chips evacuated with Ellik evacuator — estimated resected tissue weight *** grams. Final cystoscopy confirmed adequate channel, hemostasis, and intact ureteral orifices. A 22-French three-way Foley catheter placed; balloon inflated to 30 mL for traction hemostasis; continuous bladder irrigation initiated. Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: Minimal (intravascular irrigation losses not quantifiable)
SPECIMENS: Prostate chips to pathology
COMPLICATIONS: None
DRAINS: 22-Fr three-way Foley catheter to continuous bladder irrigation
DISPOSITION: Patient taken to PACU in stable condition. Admitted overnight for catheter irrigation.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Holmium laser enucleation of the prostate (HoLEP)

For larger glands (>80g). Document laser settings, enucleation of each lobe, morcellation, and specimen weight. CPT 52649.

Photoselective vaporization (GreenLight PVP)

80W or 120W KTP laser. Document laser energy delivered, vaporization of each lobe. CPT 52648.

Bipolar TURP

Note saline irrigant (eliminates TUR syndrome risk), bipolar electrode type.

Charting Tips
  • Document monopolar vs. bipolar (bipolar uses saline and eliminates TUR syndrome)
  • State irrigant used (glycine for monopolar, normal saline for bipolar)
  • Document verumontanum as distal landmark (prevents sphincter injury)
  • Note estimated resected weight (correlates with pathology)
  • Catheter traction and irrigation setup must be documented
  • All prostate chips must be sent to pathology (incidental cancer found in ~10%)
Billing Tips
  • 52601 (TURP, 9.75 wRVU) covers complete transurethral resection of the prostate for BPH using standard electrosurgical resection.
  • 52630 (resection of residual/regrowth, 6.39 wRVU) applies when TURP is performed on a gland with prior TURP. Document the prior procedure and confirm intent to code as revision.
  • 52648 (laser vaporization/enucleation of prostate, 9.80 wRVU) covers HoLEP and GreenLight laser, with nearly equivalent RVU to standard TURP.
  • Global period is 90 days (major). Post-op catheter management, irrigation, and office cystoscopy within 90 days are bundled.
  • Bladder neck contracture requiring incision within the global period uses modifier -78 (return to OR for complication) if under anesthesia, or is bundled if performed in the office.
  • Cystoscopy performed at the time of TURP for diagnostic evaluation is bundled into 52601. Do not separately bill 52000.
  • Document gland weight/volume (grams resected), as this supports medical necessity for large glands and differentiates standard TURP from procedures requiring open simple prostatectomy (57891).