Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Prostatectomy


Related Terms

  • Radical Prostatectomy
  • Retropubic Prostatectomy
  • Simple Perineal Prostatectomy
  • Suprapubic Prostatectomy
  • Transurethral Prostate Resection
  • TURP

Specialists

  • Urologist

Comorbid Conditions

  • Bladder cancer
  • Metastatic cancer
  • Obesity

Factors Influencing Duration

Length of disability may be influenced by type of surgery performed, the individual’s response, and any complications that occur. The most common disability following prostatectomy for benign conditions is urinary incontinence. Disability related to radical prostatectomy depends on the extent of the prostate cancer. The presence of metastatic cancer involving the lymph system or other organ systems may increase duration.

Medical Codes

ICD-9-CM:
17.42 - Laparoscopic Robotic Assisted Procedure; Robotic Assistance in Laparoscopic Procedure
60.21 - Transurethral (Ultrasound) Guided Laser Induced Prostatectomy (TULIP); Ablation (Contact) (Noncontact) by Laser
60.29 - Transurethral Prostatectomy, Other; Excision of Median Bar by Transurethral Approach; Transurethral Electrovaporization of Prostate (TEVAP); Transurethral Enucleative Procedure; Transurethral Prostatectomy NOS; Transurethral Resection of Prostate (TURP)
60.3 - Prostatectomy, Suprapubic; Transvesical Prostatectomy
60.4 - Prostatectomy, Retropubic
60.5 - Prostatectomy, Radical; Prostatovesiculectomy; Radical Prostatovesiculectomy; Radical Prostatectomy by Any Approach
60.61 - Local Excision of Lesion of Prostate; Excision of Prostatic Lesion by Any Approach
60.62 - Prostatectomy, Perineal; Cryoablation of Prostate; Cryoprostatectomy; Cryosurgery Of Prostate; Radical Cryosurgical Ablation of Prostate (RCSA)
60.69 - Other Prostatectomy, Other

Overview

A prostatectomy is a surgical procedure resulting in the removal of part or all of the prostate gland as a result of enlargement (benign prostatic hypertrophy) or disease (prostate cancer). The prostate gland, found only in men, surrounds the tube that leads from the bladder to the penis (urethra) and produces fluid that is a component of semen.

Two traditional approaches to a prostatectomy are transurethral resection and radical prostatectomy. A transurethral resection of the prostate (TURP) involves a partial removal of the prostrate through the urethra. TURP is performed for benign prostatic hypertrophy (BPH), a noncancerous condition in which the prostate gland is enlarged and presses in on the urethra, interfering with urine flow. TURP is not specifically used to treat prostate cancer.

The objective of a radical prostatectomy is to remove the entire prostate, the capsule that surrounds it, and the seminal vesicles. Radical prostatectomy can be performed as an open procedure or through laparoscopic surgery, a minimally invasive technique that results in shorter operative time, reduced intraoperative blood loss, and a shorter hospital stay. A radical TURP can also be performed to remove the entire prostate, but this procedure is now seldom used with the advent of more effective techniques.

A newer approach to minimally invasive radical prostatectomy using robotic assistance may be performed using either conventional laparoscopic instruments and a remotely controlled robotic arm to hold a stable camera for visualization of the prostate during surgery (automated endoscope system for optimal positioning, or AESOP system), or by using surgeon-controlled robotic arms to hold the camera and manipulate the surgical tools (da Vinci system). Advantages of the integrated computerized robotic systems include improved intraoperative visualization and depth perception, which aids in sparing nerves and muscles from injury during the operation. A shorter learning curve for surgeons makes the integrated robotic-assisted technique more readily accessible and has increased the use of laparoscopic and robotic assisted prostatectomy.

Radical prostatectomy is performed for a diagnosis of prostate cancer. The decision to use an open or laparoscopic procedure may depend on whether the cancer is confined to the prostate or has metastasized to nearby lymph nodes or other organs.

Source: Medical Disability Advisor



Reason for Procedure

A prostatectomy is performed when an enlarged prostate (prostatic hypertrophy) obstructs the flow of urine from the bladder through the urethra, leading to difficulty emptying the bladder and recurrent urinary tract infections due to urine retention. A prostatectomy also may be performed to remove tissue damaged by chronic inflammation of the prostate (prostatitis) or to treat cancer of the prostate. The goal of all prostatectomy surgery is to remove the prostate partially or completely as needed to treat the underlying condition while sparing the nerves and muscles that control urinary and sexual functions.

A TURP is performed to treat a benign (noncancerous) enlarged prostate. A radical TURP that removes all prostate tissue is sometimes performed for chronic prostatitis caused by recurrent bacterial infection. Although TURP is a theoretically appropriate approach for treating prostate cancer, it is usually not performed for this purpose because of the high rate of incontinence and impotence following this surgery and the more satisfactory results achieved with radical prostatectomies using modern techniques such as laparoscopic or robotic-assisted surgery.

Minimally invasive radical prostatectomy using the robotic-assisted endoscopic approach is primarily performed for individuals with prostate cancer that is confined to the prostate and whose preoperative workup has shown no metastasis of the primary cancer.

Source: Medical Disability Advisor



How Procedure is Performed

No abdominal incision is required with a TURP, and this procedure permits a shorter hospital stay than an open procedure. With the patient under general or spinal anesthesia, a viewing instrument (resectoscope) is passed into the urethra until the prostate can be seen. A heated wire loop, laser, or other cutting instrument is inserted through the resectoscope and used to cut away the obstructing prostate tissue. These pieces of tissue are washed out through the resectoscope. An electrode is then passed through the tube to seal off any bleeding vessels (electrocauterization). When the resectoscope is withdrawn, a tube (catheter) is passed through the urethra into the bladder. The catheter is left in place for several days to drain urine from the bladder and allow blood to be washed out while the prostate tissue heals. The technique for radical TURP is similar to standard TURP, but more prostate tissue is excised.

If the prostate gland is very enlarged (larger than 50 to 70 grams), an open prostatectomy can be performed via an incision made either in the perineal area (simple perineal prostatectomy) or the area immediately above the pubic bone (suprapubic or retropubic prostatectomy). With the patient under general anesthesia, an incision is made, exposing the bladder and prostate gland. The capsule containing the gland is opened, and the prostate tissue is removed. Bleeding vessels are cauterized. The lower abdomen (perineum) is sutured, and a catheter is passed through the urethra or a drain for urine is inserted directly into the bladder through the abdomen. The drainage tube or catheter is left in place for up to a week, or occasionally longer.

A radical prostatectomy is performed when a diagnosis of prostate cancer has been established. An open radical retropubic prostatectomy uses an incision from below the navel to the pubic bone. The prostate is mobilized by making an incision in the urethra and the bladder neck, allowing the surgeon to lift out the prostate gland. Nerve-sparing techniques help preserve urinary control and sexual function. Lymph nodes may be removed to reduce the potential spread of cancer cells. Radical perineal prostatectomy is used less often. It requires a curved incision made between the anus and scrotum. This procedure has less intraoperative bleeding but carries a greater risk of injury to the rectum, and lymph nodes cannot be removed without an additional incision. In both of these radical prostatectomies, the entire prostate including the prostatic capsule and seminal vesicles are removed, and the bladder neck is sutured directly to the remaining urethra.

Also performed under general or spinal anesthesia, the laparoscopic transperitoneal approach (AESOP system) creates five small laparoscopic incisions along the umbilicus and abdomen, through which the robot holding the visualization telescope and the surgical instruments are passed. The peritoneal fold between the rectum and bladder is incised. The prostate is separated from the rectum posteriorly, and the bladder freed of connective tissue (fascia). The bladder neck is incised, and the urethra transected to free the prostate gland and seminal vesicles. A urethrovesical anastomosis is constructed to connect the bladder neck with the urethra. A drain is placed before the incision ports are closed with sutures. The mean operating time is 4.5 hours (Fulmer).

The minimally invasive radical prostatectomy performed with an integrated robotic assistance system (da Vinci system) may use either a transperitoneal or extraperitoneal approach while the individual is under general or spinal anesthesia. With the transperitoneal approach, six small laparoscopic incisions for robotic arms, camera, and drains are made in a V-shaped configuration adjacent to the umbilicus and along the lower quadrants of the abdomen. An extraperitoneal space is established by transecting the umbilical ligaments, and removal of adjacent lymph nodes for histopathologic examination is performed. The bladder neck is then transected and the seminal vesicles freed to dissect down to the prostate, which is manipulated with traction to allow visualization for nerve sparing and then resected. The extraperitoneal approach accesses the preperitoneal space via small laparoscopic abdominal incisions, and the preperitoneum is inflated with air (insufflated) to create a space, allowing dissection to the pubic symphysis. Then, the robotic instruments are inserted two fingerbreadths above the pubis symphysis to allow retropubic access to the prostate, which is removed for histopathologic evaluation. A urethrovesical anastomosis is created, and drains and a urinary catheter are inserted before closing the incision portals with sutures.

Source: Medical Disability Advisor



Prognosis

Current techniques for laparoscopic radical prostatectomy have several advantages over open radical prostatectomy, including less blood loss, fewer transfusions, lower morbidity, reduced requirement for pain medication, shorter recovery time and hospital stays, an earlier return to work, and improved results regarding urinary and sexual function (Fulmer). If a radical prostatectomy is performed because of prostate cancer and the tumor is contained within the prostatic capsule, a majority of individuals have undetectable prostate-specific antigen (PSA) levels following surgery. This is a good indication that the cancer was completely removed. Outcomes are less predictable and generally worse if the cancer has spread to surrounding tissues or the lymph system.

Following laparoscopic radical prostatectomy, 7.3% and 9.5% of individuals had PSA recurrence at 2 and 3 years post-operatively, respectively; 52% to 66% regained potency at 12 months; and 82.3% to 84.9% of individuals regained continence at 12 months postoperatively (Fulmer).

Early results following robot assisted radical prostatectomy showed that 7.3% to 9.5% of individuals had PSA recurrence at 2 and 3 years post-operatively, 68% and 79.2% regained potency at 6 months and 12 months postoperatively, respectively, and 76% to 98% of individuals regained continence between 3 to 6 months postoperatively (Fulmer).

TURP remains the surgical treatment of choice to correct urinary obstruction due to prostatic hypertrophy; outcomes generally are favorable, with overall improvement shown in about 33% of individuals (Leslie). Radical TURP performed to treat chronic bacterial prostatitis shows overall improvement in up to 67% of patients, but the incidence of postoperative incontinence and impotence is greater than with laparoscopic prostatectomy (Leslie).

Source: Medical Disability Advisor



Complications

Complications of a TURP include excessive bleeding and transurethral resection (TUR) syndrome. TUR syndrome is a condition resulting from excessive absorption of irrigation fluids that leads to confusion, nausea, vomiting, high blood pressure, slowed heart rate, and visual disturbances. TUR syndrome occurs in about 2% of TURP cases (Leslie). Other complications include bladder perforation, failure to urinate, blood clots in the urethra, infection, scarring of the urethra, chronic incontinence, retrograde ejaculation, and impotence.

Complications of radical prostatectomy by any surgical approach include allergy or abnormal reaction to anesthetic agents, excessive bleeding, wound infection, urinary tract infection, and perforation of the bladder or rectum. Chronic incontinence occurs in about 10% of cases, and the incidence of impotence ranges from 10% to 80%, depending on the age of the individual, the extent and type of surgery, and other underlying medical conditions (Fulmer).

Complications of the laparoscopic radical prostatectomy include a 1.2% incidence of bowel injury, and incontinence rates of 10% to 15% (Fulmer).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Heavy lifting or straining should be avoided for several weeks after surgery. Time off from work or a temporary transfer to sedentary duties may be necessary, depending on the underlying reason for the prostatectomy and the individual's response to surgical treatment.

Source: Medical Disability Advisor



References

Cited

Fulmer, Brant R., Daniel B. Rukstalis, and Sanjeev Kaul. "Laparoscopic and Robotic Radical Prostatectomy." eMedicine. Eds. Edward David Kim, et al. 28 Sep. 2008. Medscape. 14 Sep. 2009 <http://emedicine.medscape.com/article/458677-overview>.

Leslie, Stephen W. "Transurethral Resection of the Prostate." eMedicine. Eds. Martha Terris, et al. 3 Oct. 2006. Medscape. 14 Sep. 2009 <http://emedicine.medscape.com/article/449781-overview>.

Source: Medical Disability Advisor






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