Excision of urethral diverticulum (separate procedure); female
CPT4 code
Name of the Procedure:
Excision of urethral diverticulum (separate procedure); female
Medical term: Urethral diverticulectomy
Summary
This surgical procedure involves the removal of a urethral diverticulum, a pocket or pouch that forms along the urethral wall in females, which can cause discomfort, recurrent infections, or urinary difficulties.
Purpose
Medical Condition: Urethral diverticulum
Goals: To relieve symptoms, prevent recurrent infections, and improve urinary function and overall quality of life.
Indications
Symptoms: Painful urination, recurrent urinary tract infections, urinary incontinence, dribbling after voiding, and dyspareunia (pain during intercourse).
Patient Criteria: Females diagnosed with a urethral diverticulum confirmed by imaging studies who experience significant symptoms affecting their daily lives.
Preparation
- Pre-Procedure Instructions: Fasting for 6-8 hours prior, adjustments to medications as advised by the physician.
- Diagnostic Tests: Urinalysis, cystoscopy, magnetic resonance imaging (MRI), or ultrasound to confirm the presence and assess the extent of the diverticulum.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A small incision is made in the vaginal wall to access the urethra.
- Dissection: The diverticulum is carefully identified and dissected from the surrounding tissues.
- Excision: The diverticulum is completely removed.
- Closure: The urethral wall and vaginal incision are closed with sutures.
- Drainage: A catheter may be placed to allow urine drainage during initial healing.
Tools and Equipment: Surgical instruments for dissection, sutures, catheter.
Duration
Typically, the procedure takes about 1-2 hours.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon: Urologist or gynecologist
- Anesthesiologist: Administers and monitors anesthesia
- Nursing Staff: Assists during surgery and provides post-operative care
Risks and Complications
Common Risks: Bleeding, infection, pain, urinary incontinence.
Rare Risks: Urethral stricture, fistula formation, recurrence of the diverticulum, anesthesia-related complications.
Management: Antibiotics for infection, pain medications, and follow-up care to monitor for complications.
Benefits
Expected Benefits: Relief from pain, reduction in recurrent infections, improved urinary function.
Timeline: Benefits typically realized within a few weeks post-surgery.
Recovery
- Post-Procedure Care: Urinary catheter care, pain management, antibiotics if needed.
- Recovery Time: Full recovery typically occurs within 4-6 weeks.
- Restrictions: Avoid strenuous activities and sexual intercourse for 4-6 weeks; follow-up appointments to monitor healing.
Alternatives
Non-Surgical Options: Observation for asymptomatic cases, antibiotic therapy for infections, pelvic floor physiotherapy.
Surgical Alternatives: Marsupialization (less invasive but not always effective).
Pros and Cons: Non-surgical options may provide temporary relief but do not cure the condition. Marsupialization may be less effective in resolving symptoms entirely compared to excision.
Patient Experience
During Procedure: Under anesthesia, no pain or awareness during surgery.
After Procedure: Mild to moderate pain managed with medications, some discomfort from the catheter.
Pain Management: Pain relief medications prescribed, and instructions for at-home care provided.