The Spanner Prostatic Stent is a temporary stent inserted into the urethra at the neck of the bladder to maintain urine flow. The Spanner benefits men with bladder outlet obstruction (BOO) by reducing elevated post void residual (PVR), improving voiding symptoms, and allowing for voluntary urination. As an alternative to a Foley Catheter, it allows your patients to naturally fill and empty their bladders.
Key Benefits of The Spanner
- Normal micturition achieved with bladder and sphincter
- Improves urination efficiency by decreasing urine left in the bladder
- Reduces rate of bacterial colonization compared to the Foley catheter
- Maintains sexual activity
- Well tolerated by patients
- Improves IPSS scores
- Greatly preferred by patients over catheterization
How It Works
The Spanner Placement
The Spanner is inserted and positioned tactilely using a detachable introducer (no cystoscopy required). The Spanner has been designed for administration in the office setting with use of a numbing agent for patient comfort.
The Spanner Removal
The stent is removed using the retrieval tether (retrieval suture) that provides for the deflation of the balloon and withdrawal of the stent.
The Spanner® Prostatic Stent has been designed to open the prostatic urethra and allow patients to maintain urine flow and allow volitional voiding by reducing urethral resistance within the prostate. As shown in the figure to the left The Spanner has a proximal balloon that is seated in the bladder neck to properly position the stent in the prostatic urethra. The stent extends from the bladder to just above the external sphincter. Device tethers (suture material) traverse the external sphincter to allow normal sphincter function, thus providing patients the ability to volitionally void. The distal anchor of the device is positioned in the bulbar urethra, just below the sphincter, to prevent device movement and migration into the bladder.
For more details about The Spanner, and to view an animation showing how the stent is inserted and removed by your healthcare professional, please take a few minutes to review the video to the left.
How The Spanner Is Provided
The stent and introducer are provided together in a sterile package. The Spanner is currently available in 20F diameter, six sizes (4, 5, 6, 7, 8 and 9 cm) with a coudé-tip. The Spanner size selection is enabled by the use of an accessory, The Surveyor™ urethral measurement device. The Surveyor is designed to assess the length of the urethra from the bladder neck to the bottom side of the external sphincter in order to select the appropriate Spanner size.
Click here for more information on The Surveyor™
Indications For Use
FDA Approved Indications for Use:
The Spanner is intended for temporary use (up to 30 days) to maintain urine flow and allow voluntary urination in patients following minimally invasive treatment for benign prostatic hyperplasia (BPH) and after initial post-treatment catheterization.
CE Approved Indications for Use:
The Spanner is indicated for temporary use (≤90 days) in men with bladder outlet obstruction (BOO) to reduce elevated post void residual (PVR) and improve voiding symptoms.
|FDA Labeling||CE Labeling|
|Positive urine culture or active urinary tract infection||Prostate medial lobe enlargement|
|History of symptomatic urinary tract disease such as urethral stricture, bladder stones, or other significant urological conditions (e.g. gross hematuria) that could affect the function of the stent||Positive urine culture or active urinary tract infection|
|Surgery altering the normal uro-genital anatomy or abnormal urethral anatomy that affects the function of the lower urinary tract||History of urinary tract disease including urethral stricture, bladder neck contracture, bladder or kidney stones, other significant urological condition or abnormal urethral anatomy|
|A prostatic urethral length less than 4 cm or greater than 9 cm (combined length from the top (proximal side) of the bladder neck to the bottom (distal side) of external sphincter)||Prior pelvic irradiation therapy|
|Prostatic urethra length > 6.6 cm or < 2.5 cm|
Patient Populations who may benefit from The Spanner:
There are several patient populations who may benefit from The Spanner as an alternative to a Foley catheter. These populations are listed in the table directly below. The table identifies the limitations in US labeling and provides literature citations for each of the patient populations.
A temporary prostatic stent is a versatile clinical tool. The Spanner stents the bladder neck and prostatic urethra while allowing the patient to maintain a full and normal lifestyle. Temporary stenting can be used to: (1) diagnose symptom etiology and predict treatment success, (2) reduce PVR and improve voiding symptoms in patients with bladder outlet obstruction, and (3) post-surgically to prevent the scarring that may occur at the bladder neck from obstructing the bladder outlet.
|FDA Labeling||CE Labeling|
|Temporary use (up to 30 days) following minimally invasive BPH treatment and after post-treatment catheterization(3, 5, 6, 7, 9)||Temporary use (≤ 90 days) in men with bladder outlet obstruction (BOO) to reduce elevated post void residual (PVR) and improve voiding symptoms|
|Differential Diagnosis of detrusor hypo-contractility(6, 8, 9)|
|Pre-treatment / Patients diagnosed with BOO(2)|
|Unfit for Surgery(4)|
|Following minimally invasive treatment of localized prostate cancer (brachytherapy, cryotherapy)(6, 7, 8)|
|Chronic Catheterization (Foley / Superpubic)(2, 6)|
|Acute Urinary Retention / Failed Voiding Trial(6)|
|Prostatic Stenosis / Bladder Neck Contracture(6, 7)|
|Postoperative retention, non-urology surgery(6)|
Instructions For Use
Patient Emergency Removal Card:
The patient is provided with an emergency removal card which he is required to keep on his person at all times. It contains step by step removal instructions for healthcare professionals in the event of an emergency.
Coding & Reimbursement
The reimbursement information provided is gathered from third-party sources and is intended to provide general information for reference purposes only. As such, SRS Medical makes no guarantee of coverage or payment. Reimbursement policies change frequently and can vary considerably from one insurer to another. SRS Medical strongly recommends that you consult your payers for interpretation of local coverage and reimbursement policies. Every reasonable effort has been made to ensure the accuracy of this information, however, the ultimate responsibility for coding and claims submission lies with the physician, clinician, hospital or other facility.
Please refer to the 2013[AW1] CPT ® manual for specific guidance (CPT is a registered trademark of the American Medical Association).
How do I code for the insertion of The Spanner?
You should use CPT code 53855 – Insertion of a temporary prostatic urethral stent, including urethral measurement. Read more about CPT and ICD-9-CM coding for The Spanner in the 2014 Quick Code Guide provided to the right.
Can I charge for supplies used during the insertion of The Spanner?
No, the supplies are included in the procedure. The practice expense portion of the RVU includes the materials and equipment necessary to perform the procedure.
Can we bill for a separate evaluation and management service in addition to the insertion of the stent?
The physician will need to indicate that on the day of the procedure the patient’s condition required a significant, separately identifiable E/M service above and beyond the services usually associated with the procedure that was performed. This circumstance may be reported by adding the modifier -25 to the appropriate level of E/M service.
How do I code for removal of The Spanner?
If the stent is removed by pulling on the tether you should code the appropriate Evaluation & Management level. There is no specific CPT code for the removal of a temporary prostatic urethral stent done in this manner.
If a cystoscopy is required to remove The Spanner you may bill using the appropriate CPT code.
The Spanner Reimbursement Support Line provides assistance for obtaining coverage and payment of The Spanner stent for the prostate. It is staffed by highly trained reimbursement professionals who are available from 9:00-6:00 PM EST to help a urologist office staff get started down the road to successful reimbursement. A Spanner reimbursement professional will respond to all inquiries within one business day regarding any of the following areas:
- Answer questions regarding coding, coverage, and payment
- Answer questions about preparing claims
- Resolve problem claims
- Appeal denied claims
Tel: 1-866-850-7607 or 1-218-338-6700
The Spanner® is widely written about with positive attestation in peer-reviewed clinical literature. Individual citations along with abstracts and links to the complete documents are provided below.