Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure, rongeur, or punch) for priapism
CPT4 code
Name of the Procedure:
Corpora cavernosa-glans penis fistulization (e.g., biopsy needle, Winter procedure, rongeur, or punch)
Summary
This procedure involves creating a fistula (an artificial opening) between the corpora cavernosa and the glans penis to alleviate persistent and painful penile erection, a condition known as priapism.
Purpose
The main goal of this procedure is to relieve the prolonged and often painful erection that does not subside on its own. This can help prevent tissue damage and preserve erectile function.
Indications
- Persistent erection lasting more than four hours (ischemic priapism)
- Severe pain associated with prolonged erection
- Risk of permanent erectile dysfunction due to prolonged priapism
Preparation
- Patients may be advised to fast for a few hours prior to the procedure.
- Blood tests and imaging studies (e.g., penile Doppler ultrasound) may be performed to assess the severity of priapism and to rule out other conditions.
- Pre-procedure consultation to review medical history and medications.
Procedure Description
- Anesthesia: Local anesthesia is generally administered to numb the area (sometimes supplemented with mild sedation).
- Insertion: A biopsy needle, punch, or surgical rongeur is used to create a fistula between the corpora cavernosa and the glans penis.
- Drainage: The created fistula allows the trapped blood to drain, thereby easing the erection.
- Post-Procedure Check: The procedure site is inspected for adequate drainage and hemostasis (control of bleeding).
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is usually performed in a hospital or outpatient surgical center.
Personnel
- Urologist or surgeon specialized in penile surgeries
- Nursing staff
- Anesthesiologist or nurse anesthetist (if sedation is needed)
Risks and Complications
- Infection at the site of the fistula
- Bleeding or hematoma formation
- Scarring or fibrosis of penile tissue
- Potential for erectile dysfunction
- Pain or discomfort during and after the procedure
Benefits
- Relief from painful erection
- Prevention of long-term damage to penile tissues
- Preservation of future erectile function
Recovery
- Patients may be advised to avoid sexual activity for a few weeks.
- Pain management with prescribed analgesics.
- Instructions on wound care and signs of infection to watch for.
- Follow-up appointments to monitor healing and efficacy.
Alternatives
- Aspiration and irrigation of corpora cavernosa
- Intracavernosal injection of sympathomimetic drugs (e.g., phenylephrine)
- Surgical shunts (more invasive options)
Patient Experience
Patients may experience mild discomfort or pain during the procedure, which can be managed with local anesthesia and pain relief medications. Post-procedure, pain and discomfort can be managed with prescribed painkillers. The area may be swollen or bruised for a few days, but most patients can return to normal activities within a week, except for sexual activity, which is usually restricted for a few weeks.