Archived Policies - Surgery
Transvaginal Radiofrequency Bladder Neck Suspension for Urinary Stress Incontinence
Transvaginal radiofrequency bladder neck suspension as a treatment of urinary stress incontinence is considered experimental, investigational and unproven.
Radiofrequency energy is a commonly used surgical tool that has been used for tissue ablation and more recently for tissue remodeling. For example, radiofrequency energy has been investigated as a treatment of gastroesophageal reflux disease (GERD), i.e., the Stretta procedure, where radiofrequency lesions are designed to alter the biomechanics of the lower esophageal sphincter, in orthopedic procedures to remodel the joint capsule, or in intradiscal electrothermal annuloplasty (IDET) procedure where the treatment is intended in part to modify and strengthen the disc annulus. In all of these procedures, nonablative levels of radiofrequency thermal energy are used to alter collagen fibrils, which then results in a healing response characterized by fibrosis. Recently, radiofrequency energy has been explored as a minimally invasive treatment option for urinary stress incontinence.
Urinary stress incontinence, defined as the involuntary loss of urine from the urethra due to an increase in intra-abdominal pressure, is a common condition, affecting 6.5 million women in the
The minimal published literature regarding transvaginal radiofrequency bladder neck suspension is inadequate to permit scientific conclusions regarding the safety and long-term efficacy of this procedure. Dmochowski and colleagues reported on a multi-institutional prospective case series of 120 consecutive women with urinary stress incontinence who underwent transvaginal radiofrequency bladder neck suspension. Enrolled patients had failed at least a 3-month trial of conservative therapy, including most commonly pelvic floor muscle exercises or pelvic floor stimulation. Follow-up examinations at one, three, six, and twelve months consisted of a history, physical examination, and urodynamic studies. In addition, each patient completed a voiding diary and quality of life questionnaire. Cured was defined as a negative Valsalva maneuver; improved was defined as decreased daily episodes of pad use. A total of 73% of patients were considered cured or improved at twelve months. More than 68% of patients reported satisfaction with the treatment. The authors conclude that the results are encouraging and that a 73% 12-month success rate suggests that this procedure has applicability for women with refractory incontinence who do not wish to undergo a more complicated surgical procedure. Ross and colleagues conducted a multicenter, prospective single-arm study that included 94 women with stress incontinence. At 1 year the objective cure rate was 79% at twelve months based on a negative leak point pressure. Assessment of quality of life was also significantly improved. Larger controlled studies with longer follow-up are needed to further evaluate this procedure. As noted in a review of laparoscopic bladder neck suspension, initial promising results at twelve months declined to a 30% success rate at forty-five months. These authors suggest that any new surgical technique for the treatment of stress incontinence should have more than two years of follow up.
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There are no specific CPT codes describing this procedure. It is likely that the nonspecific CPT code 53899 (unlisted procedure, urinary system) would be used.
Medicare does not have a national position on this service. It is subject to local carrier discretion. Please refer to the local carrier for more information.
Dmochowski, R.R., Avon, M., et al. Transvaginal radio frequency treatment of the endopelvic facsia: a prospective evaluation for the treatment of genuine stress urinary incontinence. Journal of Urology (2003) 169(3):1028-32.
Ross, J.W., Galen, D.I., et al. A prospective multisite study of radiofrequency bipolar energy for treatment of genuine stress incontinence. Journal of American Association Gynecologic Laparoscopists. (2002) 9(4):493-9.
McDougall, E.M., Heidorn,
|Title:||Effective Date:||End Date:|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||07-15-2017||04-14-2018|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||06-01-2016||07-14-2017|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||04-15-2015||05-31-2016|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||04-01-2012||04-14-2015|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||02-15-2010||03-31-2012|
|Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUI)||08-01-2007||02-14-2010|
|Transvaginal Radiofrequency Bladder Neck Suspension for Urinary Stress Incontinence||05-01-2005||07-31-2007|