54348 Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring extensive dissection and urethroplasty with flap, patch or tubed graft (includes urinary diversion)

Name of the Procedure:

Repair of Hypospadias Complications (Extensive Dissection and Urethroplasty with Flap, Patch, or Tubed Graft; Including Urinary Diversion)

Summary

This procedure addresses complications arising from previous hypospadias repair surgeries, such as fistulas, strictures, or diverticula. It involves extensive dissection and reconstruction of the urethra using tissue grafts or flaps to restore normal function and urinary flow.

Purpose

This procedure aims to correct structural issues in the urethra that developed after prior hypospadias surgeries. The goals include restoring proper urinary function, reducing discomfort or pain, and preventing further complications related to the urinary tract.

Indications

• Presence of fistulas (abnormal connections between the urethra and the skin)
• Urethral strictures (narrowing of the urethra)
• Diverticula (pouch-like protrusions along the urethra)
• Persistent urinary issues following previous hypospadias repairs
• Discomfort or pain during urination
• Infections caused by structural abnormalities

Preparation

• Patients may need to fast for a specific period before surgery.
• Discontinuation or adjustment of certain medications as advised by the healthcare provider.
• Pre-operative assessments including blood tests, urine tests, and imaging studies (e.g., ultrasound, MRI) may be required.
• Consultation with the anesthesiologist prior to the surgery.

Procedure Description

1. Administration of general anesthesia to ensure the patient is fully unconscious and pain-free.
2. A detailed examination and mapping of the existing structural issues in the urethra.
3. Extensive dissection to remove scar tissue or other obstructions.
4. Urethroplasty, wherein tissue grafts or flaps are harvested from other areas of the body (e.g., buccal mucosa, bladder) and used to reconstruct the urethra.
5. Possible creation of a temporary urinary diversion to allow the new urethral tissue to heal without exposure to urine.
6. Closure of the surgical site with sutures or adhesives.
7. Placement of a catheter to ensure urine drainage and to support the healing urethra.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity of the repairs needed.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• A urologic surgeon
• An anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Recurrence of fistulas or strictures
• Urinary incontinence
• Adverse reactions to anesthesia
• Pain or discomfort during recovery
• Potential need for additional surgeries if initial repair is unsuccessful

Benefits

• Improved urinary function
• Reduced pain or discomfort during urination
• Decreased risk of urinary infections
• Enhanced quality of life
• Long-term resolution of complications from previous hypospadias repairs

Recovery

• Hospital stay for monitoring, typically 1 to 3 days post-procedure.
• Use of a urinary catheter for 1 to 2 weeks to aid in healing.
• Pain management with prescribed medications.
• Follow-up appointments for removal of the catheter and monitoring of the healing process.
• Limitation of physical activity and avoidance of straining for several weeks.
• Possible use of antibiotics to prevent infection.

Alternatives

• Conservative management with regular dilations for minor strictures
• Endoscopic procedures for limited urethral obstructions
• Repeat or revision urethroplasty with less extensive grafting if suitable
• Each alternative comes with its unique risks and benefits; surgical repair with extensive dissection is generally considered for more severe or recurrent cases.

Patient Experience

• Discomfort from the urinary catheter and surgical site can be expected.
• Pain and swelling in the area of the repaired urethra, manageable with medications.
• Initial difficulties with urination and possible adjustments over time as healing progresses.
• Regular monitoring and follow-up to ensure successful recovery and address any arising issues.