Benign prostatic hyperplasia (BPH) is a chronic age-related condition associated with symptoms of having to urinate frequently, urgently and many times throughout the night. The condition affects half of men between 50 and 60 years of age and more than 90% of men aged 80 years and older. More than 13 million men in the United States have symptomatic BPH, and there are many thousands of transurethral resections of the prostate (TURP) performed each year.

Now men have a better treatment option. The prostatic urethral lift is a minimally invasive cystoscopic procedure that can be performed in about 10 minutes in surgery centers or office spaces with the patient under oral or conscious sedation. Instead of removing tissue, surgeons apply a mechanical fix to a mechanical problem: Pulling collapsed walls of the prostate apart with small implants. By offering the procedure, you'll increase case volume because the indication threshold is lower than for the traditional TURP surgery and patient demand has increased. Surgery centers are ideal for the procedure with throughput times of 45 minutes to one hour from admission to discharge.

Patients undergoing a lift receive oral sedation with valium or hydrocodone and a local anesthetic after being prepped and draped in the lithotomy position. Nurses place viscous lidocaine in the urethra or 4% liquid lidocaine in the bladder for 10 minutes prior to the procedure.

Surgeons then pass a rigid cystoscope through the urethra to push the obstructing prostate lateral lobes to the side. They then place a series of polypropylene implants — a minimum of two, a maximum of seven or eight — in order to open the prostatic urethra. Each implant can be fired and deployed in a matter of seconds. The procedure can be completed in 20 minutes or less. Patients are in the facility for about an hour in total.

Patients recover quickly and return to normal life activities in three to five days.

Data show 86% of patients don't need retreatment, reoperation or alternative treatment at five years post-op. Measurement of voiding function, based on flow rate and pressure, before and after surgery shows lift is about 75% effective as TURP in improving urinary flow rates, enough to achieve significant improvement and reduction in voiding symptoms. Patient satisfaction after the lift procedure is very high because the approach is not as invasive as TURP and doesn't negatively impact the ability to achieve erections or ejaculate.

The lift has two assigned APC codes: 5375 and 5376. The unadjusted facility reimbursement amount for the first 3 implants placed is approximately $3,117; reimbursement climbs to $6,505 for up to six implants. The implants cost about $950 each. Placing four therefore eats into about half of the reimbursement, but overall the lift is a reasonably profitable procedure based on the number of implants used.

I can complete three lifts in the amount of time it takes to do two TURPs. Realistically, I can perform 60 to 100 lifts per year. Being able to perform more cases adds to the procedure's profit potential. There's also no global follow-up period on the lift procedure, compared with a 90-day global period for TURP.

Some younger men who have been avoiding TURP due to interest in preserving their sexual function are more likely to schedule a lift procedure. Patients seek me out because they're looking for an alternative to TURP, and many of my satisfied patients refer friends and family to me. OSM