54304 Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

Name of the Procedure:

Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

Summary

This surgical procedure aims to correct congenital penile abnormalities such as chordee (a downward curvature of the penis) or the first stage of hypospadias repair, a condition where the urethra opens on the underside of the penis rather than at the tip. The surgery can involve the transplantation of preputial (foreskin) tissue or skin flaps to reconstruct the penile structures.

Purpose

The procedure addresses congenital penile deformities:

• Chordee: Correcting the curvature to allow normal appearance and function.
• Hypospadias: Fixing the urethral opening's position to facilitate normal urination and sexual function.

The goal is to improve both the cosmetic appearance and functional aspects of the penis.

Indications

• Chordee: Presenting with a noticeable penile curvature, especially if it hinders sexual function or causes discomfort.
• Hypospadias: When the urethral opening is abnormally positioned, associated with difficulties in urination or higher risk of urinary tract infections.

Patients are generally evaluated based on the severity of the condition and the impact on quality of life.

Preparation

• Fasting: Patients are usually required to fast several hours before surgery.
• Medication Adjustments: Certain medications may need to be discontinued prior to the procedure.
• Diagnostic Tests: Preoperative imaging and urinalysis may be needed to assess the extent of the condition and plan the surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and free of pain.
2. Incisions: Strategic incisions are made on the penis, often including around the area of curvature or hypospadiac urethra.
3. Correction: For chordee, the surgeon releases the tissues causing the curvature. For hypospadias, the abnormal urethral opening is corrected and the urethra is reconstructed.
4. Tissue Transplantation: Preputial tissue or skin flaps may be transplanted to cover the surgical site and aid in the reconstruction.
5. Closure: The surgical sites are closed with sutures, which may dissolve on their own or need to be removed later.

Duration

The procedure typically lasts between 1 to 3 hours, depending on the complexity of the case.

Setting

The surgery is performed in a hospital or a surgical center equipped for pediatric or adult urological surgeries.

Personnel

• Surgeon: Performs the procedure.
• Anesthesiologist: Administers anesthesia and monitors the patient.
• Nurses and Surgical Technicians: Assist before, during, and after the procedure.

Risks and Complications

• Common Risks: Infection, bleeding, and swelling.
• Rare Risks: Urethral fistulas, scarring, strictures, and dissatisfaction with cosmetic results.

Management of complications may involve medications, additional surgeries, or extended recovery times.

Benefits

• Benefits: Improved penile appearance and function, normalized urination, and reduced risk of urinary tract infections.
• Timeline: Benefits are typically realized gradually over weeks to months as the area heals and the tissues settle.

Recovery

• Post-Procedure Care: Instructions include hygiene practices, pain management with medications, and activity restrictions.
• Expected Recovery Time: Approximately 4 to 6 weeks for initial healing. Full recovery may take several months.
• Follow-Up: Regular appointments to monitor healing and functionality.

Alternatives

• Non-Surgical Management: Observation and symptom management if the condition is mild and does not impact quality of life.
• Other Surgical Techniques: Alternative reconstructive procedures may be considered depending on the specific condition and severity.

Patient Experience

• During the Procedure: Patients will be under general anesthesia and unaware of the surgery.
• After the Procedure: Some pain and discomfort are expected, manageable with prescribed pain relievers. The area may be swollen and bruised initially.
• Pain Management: Medications and sometimes regional anesthesia (nerve blocks) help manage post-operative pain effectively.

Overall, patients should expect to gradually regain normal function and appearance of the penis, with careful adherence to post-operative care and follow-up instructions.