Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft
CPT4 code
Name of the Procedure:
Repair of hypospadias complications (i.e., fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft.
Summary
This surgical procedure addresses complications from previous hypospadias repairs, such as urethral fistulas, strictures, or diverticula. The repair involves mobilizing skin flaps and reconstructing the urethra using a flap or patch graft to restore normal urinary function and appearance.
Purpose
The procedure is aimed at correcting complications that arise from previous hypospadias surgeries. These issues can affect urinary function and cause discomfort or recurrent infections. The goal is to ensure a functional urethra and improve the patient's quality of life by resolving these complications.
Indications
- Presence of urethral fistula (an abnormal connection between the urethra and the skin)
- Urethral stricture (narrowing of the urethra)
- Urethral diverticula (outpouchings in the urethra)
- Recurrent urinary tract infections or difficulty urinating
This procedure is appropriate for patients experiencing complications from past hypospadias surgeries that significantly impact their urinary function or quality of life.
Preparation
- Patients may be advised to fast (no eating or drinking) starting the night before the surgery.
- Certain medications, particularly anticoagulants, may need to be adjusted or stopped.
- Preoperative assessments may include blood tests, urine tests, and imaging studies of the urinary tract.
Procedure Description
- Anesthesia: The patient will be placed under general anesthesia.
- Incision and Exposure: The surgeon will make an incision to expose the affected area.
- Mobilization of Skin Flaps: Skin flaps around the urethra will be carefully mobilized to provide adequate tissue for the repair.
- Urethroplasty: A graft from another part of the body, or a local flap, will be used to reconstruct the urethra. This may involve creating a new channel for urine flow.
- Closure: The surgical site is then closed, taking care to ensure proper alignment and functionality.
Tools and equipment used include surgical scalpels, tissue forceps, sutures, and graft materials. The procedure is performed under general anesthesia.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity of the repair needed.
Setting
The procedure is performed in a hospital operating room or a specialized surgical center.
Personnel
- Urologist or Pediatric Urologist (surgeon)
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection
- Bleeding
- Recurrence of fistulas, strictures, or diverticula
- Scarring
- Urinary incontinence or retention
- Need for additional surgeries
Benefits
- Improved urinary function
- Resolution of discomfort
- Reduced risk of infections
- Enhanced quality of life Benefits are usually noticed gradually over several weeks following the surgery.
Recovery
- Initial post-procedure recovery involves hospital stay for monitoring.
- Pain management using prescribed medications.
- Patients may need to use a urinary catheter for a short period.
- Avoid strenuous activities for several weeks.
- Follow-up appointments to monitor healing and ensure the success of the repair are crucial.
- Full recovery may take several weeks to a few months.
Alternatives
- Observation and non-surgical management, although these are less effective for significant complications.
- Repeat minor corrective procedures if the issues are minimal.
Alternatives vary in effectiveness and may carry their own risks and benefits compared to a full reconstructive surgery.
Patient Experience
Patients will be under anesthesia during the procedure and will not feel pain. Post-surgery, they may experience discomfort and will be provided pain management options. Some swelling and bruising are expected initially. Adherence to post-operative care instructions will aid in a smoother recovery. Regular follow-ups are necessary to assess the success of the repair and to address any complications promptly.