Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure)
CPT4 code
Name of the Procedure:
Cystotomy for Excision of Bladder Diverticulum (single or multiple)
Summary
Cystotomy for excision of bladder diverticulum is a surgical procedure that involves making an incision in the bladder to remove outpouchings of the bladder wall, known as diverticula. These outpouchings can be single or multiple.
Purpose
The procedure addresses conditions involving bladder diverticula, which can cause urinary retention, recurrent infections, bladder stones, or even cancer. The goal is to remove these diverticula to alleviate symptoms, reduce the risk of complications, and improve bladder function.
Indications
- Recurrent urinary tract infections
- Urinary retention
- Presence of bladder stones
- Hematuria (blood in the urine)
- Risk or presence of malignancy within the diverticulum
- Symptoms of bladder outlet obstruction
Preparation
- Fasting for at least 8 hours prior to the surgery
- Adjustments to regular medications as advised by the doctor
- Pre-operative diagnostic tests like urinalysis, urine culture, cystoscopy, and imaging studies (ultrasound, CT scan)
Procedure Description
- The patient is placed under general anesthesia.
- A catheter is inserted into the urethra to empty the bladder.
- A surgical incision is made in the lower abdomen to access the bladder.
- The bladder is opened to identify and excise the diverticulum.
- Each diverticulum is carefully removed, and the bladder wall is then sutured closed.
- The abdominal incision is closed with sutures or staples.
Duration
The procedure typically takes 1 to 3 hours, depending on the complexity and number of diverticula.
Setting
The procedure is usually performed in a hospital or a specialized surgical center.
Personnel
- Urologic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Urine leakage
- Bladder dysfunction or incontinence
- Blood clots
- Anesthesia-related risks
Benefits
- Relief of urinary symptoms
- Reduction of recurrent infections
- Lower risk of bladder stone formation
- Prevention of potential malignancy within diverticula
Recovery
- Hospital stay for a few days post-procedure
- Catheter in place for several days to weeks
- Pain management with prescribed medications
- Gradual return to normal activities over 4 to 6 weeks
- Follow-up appointments to monitor healing and bladder function
Alternatives
- Non-surgical management with antibiotics for infections
- Regular monitoring and surveillance for asymptomatic diverticula
- Endoscopic procedures (less invasive but maybe less effective for extensive diverticula)
- Each alternative’s efficacy and suitability vary based on individual patient conditions.
Patient Experience
Patients may experience discomfort and pain post-surgery, managed with medication. Temporary bladder catheterization may cause slight irritation. Overall, patients should gradually feel symptom relief and improvement in urinary function as they heal.