54352 Repair of hypospadias cripple requiring extensive dissection and excision of previously constructed structures including re-release of chordee and reconstruction of urethra and penis by use of local skin as grafts and island flaps and skin brought in as f

Name of the Procedure:

Repair of Hypospadias Cripple (Technical name: Complex Hypospadias Repair)

Summary

This procedure involves surgically correcting severe complications from prior hypospadias surgeries. It includes extensive dissection and removal of previously constructed structures, releasing curvature of the penis (chordee), and reconstructing the urethra and penis using local skin grafts, island flaps, and possibly skin brought from other areas.

Purpose

Medical Condition: Severe hypospadias and complications from previous surgeries. Goals: Establish proper urinary function, correct penile curvature, improve cosmetic appearance, and enhance overall function and health of the penis.

Indications

• Persistent or severe penile curvature
• Urethral strictures or fistulas
• Failed previous hypospadias repairs
• Significant cosmetic or functional concerns

Preparation

• Pre-procedure Instructions: Fasting for 8 hours prior, adjustments in medication as advised.
• Diagnostic Tests: Urinalysis, blood tests, imaging studies, and detailed physical examination.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision and Exposure: The surgeon makes precise incisions to access and dismantle previously constructed structures.
3. Chordee Release: Corrects penile curvature by releasing tethered tissues.
4. Urethral Reconstruction: Constructs a new urethra using local skin grafts and island flaps.
5. Penile Reconstruction: Reconstructs the penis using local tissue and possibly skin brought from other areas.
6. Closure: Sutures are used to close the incisions, and dressings are applied.

Duration

The procedure typically takes 4 to 6 hours, depending on the complexity.

Setting

Usually performed in a hospital surgical suite or a specialized surgical center.

Personnel

• Lead surgeon (urologist/ pediatric urologist)
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Common Risks: Infection, bleeding, and swelling.
• Rare Risks: Urethral fistula, recurrent chordee, graft or flap failure, and complications from anesthesia.
• Management: Includes antibiotics for infection, drainage for hematomas, and possible further surgeries for severe complications.

Benefits

• Improved urinary function and flow.
• Corrected penile curvature.
• Enhanced cosmetic appearance.
• Generally, improvements can be noticed within weeks, though full benefits might take longer.

Recovery

• Post-procedure care: Pain management with prescribed medications, catheter care.
• Restrictions: Limited physical activity for several weeks.
• Follow-up: Regular follow-ups for suture removal, monitoring healing, and addressing any complications.

Alternatives

• Conservative management for less severe cases.
• Other surgical options like single-stage procedures.
• Pros and Cons: Conservative options may not address severe issues, while other surgeries might have different risk profiles.

Patient Experience

• During Procedure: Under general anesthesia, the patient will not feel pain or be aware of the surgery.
• After Procedure: Possible discomfort controlled by pain medication. Swelling and bruising can be expected. Ongoing communication with the healthcare team will ensure comfort throughout recovery.