Plastic operation of penis for straightening of chordee (eg, hypospadias), with or without mobilization of urethra
CPT4 code
Name of the Procedure:
Plastic Operation of Penis for Straightening of Chordee (e.g., Hypospadias), With or Without Mobilization of Urethra
Summary
This procedure involves the surgical correction of penile curvature, often associated with hypospadias, a condition where the urethral opening is not located at the tip of the penis. The surgery may also involve repositioning the urethra to its normal location.
Purpose
The procedure addresses congenital or acquired penile curvature (chordee) and hypospadias. The expected outcome is a straightened penis that functions normally for urination and sexual activity, improving both physical appearance and function.
Indications
- Penile curvature that causes functional issues or significant cosmetic concerns.
- Hypospadias where the urethral opening is atypically positioned.
- Difficulty with urination due to the abnormal urethral opening location.
- Pain or discomfort during erections.
Preparation
- Patients are usually instructed to fast for 8-12 hours before surgery.
- Some medications may need to be paused as recommended by the healthcare provider.
- Preoperative blood tests and a physical examination are typically required.
- Imaging studies like ultrasounds may be conducted to assess the degree of chordee.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made along the underside of the penis to access and straighten the chordee.
- If needed, the urethra is mobilized and repositioned to the correct anatomical location.
- Grafts or flaps may be used to aid in straightening and urethral reconstruction.
- The incision is closed with sutures, and a dressing is applied to the surgery site.
Duration
The procedure typically takes 2 to 3 hours, depending on the complexity.
Setting
The surgery is performed in a hospital or specialized surgical center.
Personnel
- A urologist or pediatric urologist (if the patient is a child)
- Anesthesiologist
- Surgical nurses
- Surgical technicians
Risks and Complications
Common risks include infection, bleeding, and swelling. Rare complications may involve urethral fistula (an abnormal connection), scarring, or recurrence of the curvature. Strict monitoring and follow-up care help manage these risks.
Benefits
- Correction of penile curvature.
- Improved urinary function.
- Enhanced cosmetic appearance.
- Relief from pain or discomfort during erections.
- Improved psychological and sexual well-being.
Recovery
- Post-operative care includes pain management and cleaning of the surgical site.
- Patients may need to avoid strenuous activities and sexual intercourse for 4-6 weeks.
- Follow-up appointments are scheduled to monitor healing.
- Full recovery typically takes 6-8 weeks.
Alternatives
- Non-surgical options include penile traction devices for mild curvature but are often less effective.
- Hormonal treatment might be considered if there is an underlying endocrine issue, but it doesn't correct physical curvature.
- Pros and cons should be discussed with a healthcare provider.
Patient Experience
Most patients may experience pain and swelling initially, managed with prescribed pain medications. Discomfort during urination may be felt, but it should subside within a week. Continuous reassurance, along with clear instructions on wound care and activity limitations, helps ensure a smooth recovery.