Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type)
CPT4 code
Name of the Procedure:
Urethroplasty: First Stage for Fistula, Diverticulum, or Stricture (e.g., Johannsen type)
Summary
Urethroplasty is a surgical procedure aimed at repairing or reconstructing the urethra to address issues such as fistulas, diverticula, or strictures that obstruct urine flow. The first stage, often following the Johannsen method, involves creating a temporary opening.
Purpose
Urethroplasty addresses:
- Urethral fistulas (abnormal connections between the urethra and another organ)
- Urethral diverticula (pouch-like outgrowths of the urethra)
- Urethral strictures (narrowing of the urethra due to scar tissue)
The goals are to:
- Restore normal urine flow
- Eliminate infections and discomfort
- Improve the quality of life
Indications
The procedure is indicated for patients with:
- Recurrent urinary tract infections
- Difficulty or pain during urination
- Significant urinary incontinence
- Evidence of urethral obstructions or abnormalities on imaging tests
Preparation
Patients may need to:
- Fast for a certain period before the surgery
- Adjust or stop certain medications
- Undergo preoperative diagnostic tests such as imaging studies and urine tests
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the genital area to access the urethra.
- The surgeon identifies and isolates the affected segment.
- A temporary opening (urethrostomy) is created to reroute urine flow to an external bag.
- Additional steps may include tissue grafting or preparing the site for a second-stage operation.
- The surgical site is closed, and dressings are applied.
Tools and equipment might include scalpels, retractors, sutures, and grafting materials.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity.
Setting
The surgery is usually performed in a hospital operating room or a specialized surgical center.
Personnel
The procedure involves:
- Surgeons, typically specialized in urology
- Anesthesiologists
- Operating room nurses
- Surgical assistants
Risks and Complications
Risks include:
- Infection
- Bleeding
- Pain at the surgical site
- Scarring
- Urinary incontinence
- Need for additional surgeries
- Rare complications such as deep vein thrombosis or adverse reactions to anesthesia
Benefits
Expected benefits include:
- Improved urinary function
- Relief from symptoms like pain and recurrent infections
- Better overall quality of life Benefits might be noticeable within weeks of recovery.
Recovery
Post-procedure care involves:
- Monitoring for signs of infection
- Managing pain with medications
- Regular follow-ups to assess healing
- Restrictions on heavy lifting and strenuous activity for several weeks
- Gradual return to normal activities based on the doctor's advice
Alternatives
Alternative treatments might include:
- Endoscopic procedures such as urethrotomy
- Permanent urinary diversion
- Conservative management with catheters Alternatives may have varying success rates and recovery profiles.
Patient Experience
Patients might experience some discomfort, mild pain, and swelling post-surgery. Pain can be managed with prescribed medications. Most patients will need a urinary catheter for a period post-surgery. Initial days may involve restricted movement, but most can return to normal activities within a few weeks. Regular follow-up is essential to monitor healing and plan for any subsequent surgical stages if required.