Urethroplasty; second stage (formation of urethra), including urinary diversion
CPT4 code
Name of the Procedure:
Urethroplasty; Second Stage (Formation of Urethra) with Urinary Diversion
Summary
Urethroplasty is a complex surgical procedure aimed at reconstructing the urethra, often performed in stages. The second stage focuses on forming the new urethra and may involve urinary diversion to ensure proper healing and functionality.
Purpose
The procedure is primarily aimed at addressing urethral stricture disease, trauma, or congenital abnormalities that disrupt normal urinary function. The goals include restoring a normal urinary flow, resolving associated symptoms, and improving overall quality of life.
Indications
- Severe urethral stricture
- Traumatic injury to the urethra
- Congenital urethral abnormalities
- Multiple previous failed urethral surgeries
Preparation
- Fasting typically required 8 hours before surgery.
- Adjustments to medications as directed by the surgeon.
- Preoperative imaging studies like an MRI or retrograde urethrogram.
- Blood tests and a pre-anesthetic evaluation.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision and Exposure: An incision is made to access the urethra.
- Formation of Urethra: The new urethra is formed using grafts (often from the patient's own tissue, like the buccal mucosa).
- Urinary Diversion: A catheter or stent is inserted to divert urine away from the surgical site, ensuring proper healing.
- Closure and Dressing: Incisions are closed and dressed appropriately.
Duration
The procedure typically takes 3 to 6 hours, depending on the complexity of the case.
Setting
The procedure is performed in a hospital setting, typically in an operating room equipped for complex surgeries.
Personnel
- Lead Surgeon: Urologist with specialized training in urethral reconstruction.
- Surgical Assistants: Additional surgeons or surgical residents.
- Anesthesiologist: Administers anesthesia and monitors vital signs.
- Nursing Staff: Assists during surgery and provides postoperative care.
Risks and Complications
- Infection
- Bleeding
- Anastomotic stricture or failure
- Fistula formation
- Anesthetic complications
- Urinary incontinence
Benefits
- Restoration of normal urinary flow.
- Relief from symptoms such as pain and urinary retention.
- Improved quality of life and comfort.
- Reduced risk of recurrent urinary tract infections.
Recovery
- Hospital stay of 2-4 days postoperatively.
- Urinary catheter remains in place for 2-3 weeks.
- Follow-up appointments to monitor healing and remove the catheter.
- Restrictions on heavy lifting and strenuous activity for 4-6 weeks.
- Pain management with prescribed medications.
Alternatives
- Endoscopic urethrotomy (less invasive but higher recurrence rate).
- Permanent urinary diversion (for severe cases not suitable for reconstructive surgery).
- Observation and management of symptoms (for non-progressive mild cases).
Patient Experience
- Patients may feel discomfort and require pain management postoperatively.
- A sensation of pressure or fullness due to the urinary catheter is common.
- Psychosocial support and reassurance play a vital role in recovery.
- Most pain and discomfort typically subside within a few days post-surgery.