Urethroplasty for second stage hypospadias repair (including urinary diversion) with free skin graft obtained from site other than genitalia
CPT4 code
Name of the Procedure:
Urethroplasty for Second Stage Hypospadias Repair (with Urinary Diversion) using Free Skin Graft (Non-Genital)
Summary
This procedure is a surgical repair for hypospadias, a birth defect affecting the urethra in males. This second-stage operation involves creating or reconstructing the urethra using a skin graft from a part of the body other than the genital area, along with a temporary urinary diversion to aid healing.
Purpose
The primary aim is to correct hypospadias, which is a condition where the urethral opening is not located at the tip of the penis. The procedure helps achieve normal urination, improved cosmetic appearance, and better sexual function.
Indications
- Presence of hypospadias uncorrected by an initial surgery
- Urethral stricture or fistula
- Difficulty in urination
- Adverse healing from a previous hypospadias repair
Preparation
- Patients may need to fast for a specific period before surgery.
- Pre-operative blood tests, urinalysis, and imaging studies might be required.
- Adjustment or cessation of certain medications as advised by the surgeon.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made in the penile area to expose the urethra.
- Graft Harvesting: A free skin graft is obtained from a non-genital area, such as the inner arm or thigh.
- Urethroplasty: The harvested graft is used to reconstruct or create the new urethra.
- Urinary Diversion: A catheter or stent is placed to divert urine flow temporarily, allowing the new urethral segment to heal properly.
- Closure: The incision sites are closed with sutures.
Duration
The procedure typically takes 3 to 5 hours, depending on the complexity.
Setting
The surgery is performed in a hospital operating room or a specialized surgical center.
Personnel
- Urologist or pediatric surgeon
- Surgical nurses
- Anesthesiologist
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Graft failure or rejection
- Urethral stricture or fistula recurrence
- Anesthetic complications
Benefits
- Restoration of normal urination
- Improved cosmetic appearance
- Enhanced sexual function
- Relief from symptoms causing discomfort or inconvenience
Recovery
- Hospital stay for a few days post-surgery for monitoring
- Pain management with prescribed medications
- Instructions for catheter care and hygiene
- Limit physical activity for several weeks
- Follow-up appointments for suture removal and assessment of healing
Alternatives
- First-stage urethroplasty (if not already performed)
- Perineal urethrostomy (an alternative urinary tract reconstruction)
- Watchful waiting (if symptoms are mild and manageable)
Patient Experience
- During the procedure: Patient will be under general anesthesia and unconscious.
- After the procedure: Some pain and discomfort at the incision site, managed with medications. Urinary catheter will cause some inconvenience until removed. Regular follow-up visits to ensure satisfactory healing.
For more detailed information and personalized guidance, always consult with the healthcare provider performing the procedure.