54390 Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder

Name of the Procedure:

Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder

Summary

This surgical procedure involves reconstructive surgery to correct epispadias in males, a condition where the urethra does not develop properly and is located on the top of the penis, rather than the tip. This particular procedure addresses cases where epispadias is accompanied by bladder exstrophy, a condition where the bladder is turned inside out and exposed outside the body.

Purpose

• Medical Condition: Treats epispadias and bladder exstrophy.
• Goals/Outcomes: To reconstruct the urethra and penis, close the bladder, and position it inside the pelvis, allowing the patient to urinate normally and improving cosmetic appearance and sexual function.

Indications

• Symptoms include abnormal location of the urethra, urinary incontinence, exposed bladder, and underdeveloped genitalia.
• Suitable for patients typically diagnosed at birth or in early childhood with a confirmed case of epispadias and bladder exstrophy through physical and imaging examinations.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Preoperative assessments include physical examinations, imaging studies (e.g., ultrasound, MRI), and blood tests.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Bladder Repair: The exposed bladder is closed and positioned inside the pelvis.
3. Urethral Reconstruction: The urethra is reconstructed to its proper location and function.
4. Penile Reconstruction: Cosmetic and functional reconstruction of the penis is performed.
5. Tool/Equipment: Scalpel, sutures, catheters, and specialized reconstructive surgery tools.

Duration

The procedure typically takes several hours, depending on the severity of the conditions.

Setting

The surgery is performed in a hospital operating room under sterile conditions.

Personnel

• A team of specialized pediatric or reconstructive surgeons.
• Anesthesiologists.
• Surgical nurses and assistants.

Risks and Complications

• Common risks include bleeding, infection, and pain.
• Rare but serious complications might include anesthesia reactions, damage to surrounding tissues, and complications requiring additional surgeries.
• Long-term risks involve urinary incontinence or recurrent urinary tract infections.

Benefits

• Improved urinary function and continence.
• Enhanced cosmetic appearance and potential improvement in sexual function.
• Benefits are generally realized within a few weeks to months post-surgery.

Recovery

• Hospital stay for several days post-surgery.
• Care includes pain management, catheter care, and monitoring for complications.
• Expected recovery time can range from a few weeks to a couple of months.
• Follow-up appointments are necessary to monitor healing and function.

Alternatives

• Non-surgical management is very limited and generally not viable for these conditions.
• Surgical alternatives might involve staged procedures or different techniques, though they carry similar risks and benefits.

Patient Experience

• During the procedure, the patient will be under general anesthesia and feel nothing.
• Post-surgery, patients might experience moderate pain, managed with medication.
• Discomfort from catheters and limited mobility initially, gradually improving as healing progresses.