CPT® Code 37788

1. Indications

Penile revascularization is indicated for patients experiencing penile arterial insufficiency, which can lead to erectile dysfunction. The specific conditions or symptoms that may warrant this procedure include:

• Penile Arterial Insufficiency A condition characterized by inadequate blood flow to the penis, resulting in difficulties achieving or maintaining an erection.
• Erectile Dysfunction A common condition where a man is unable to achieve or maintain an erection sufficient for satisfactory sexual performance.
• Arteriosclerotic Disease A disease process that leads to the hardening and narrowing of arteries, potentially affecting blood supply to the penis.
• Trauma to the Pelvis or Perineum Injuries in these areas that may disrupt normal blood flow to the penile region.
• Other Organic Disease Processes Various medical conditions that may impair vascular function and contribute to erectile dysfunction.

2. Procedure

The procedure for penile revascularization involves several critical steps to restore blood flow to the penis. These steps include:

• Step 1: Exposure and Dissection The inferior epigastric artery is exposed and carefully dissected free from surrounding tissues up to the level of the umbilicus. This step is crucial for accessing the artery that will be anastomosed to the corpus cavernosum.
• Step 2: Transection and Tunneling Once the artery is adequately exposed, it is transected and then passed through a subcutaneous tunnel that leads to the base of the penis. This tunneling is necessary to position the artery correctly for the anastomosis.
• Step 3: Exposure of the Tunica Albuginea The tunica albuginea, which is the fibrous envelope surrounding the corpus cavernosum, is exposed. A small plug of tissue is excised to facilitate the anastomosis.
• Step 4: Anastomosis Using microsurgical techniques, the transected artery is anastomosed to the endothelium of the corpus cavernosum. This connection is vital for restoring blood flow and is monitored for evidence of erection following the procedure.
• Step 5: Closure of Surgical Incisions After confirming the anastomosis, the surgical incisions are closed in a layered fashion to promote proper healing.
• Step 6: Harvesting the Vein Graft (if applicable) If a vein graft is required, such as a saphenous vein graft, an incision is made in the leg over the section of the saphenous vein to be harvested. The soft tissue is dissected off the vein, and branches are ligated and divided.
• Step 7: Vein Graft Anastomosis The selected section of the saphenous vein is ligated proximally and distally, divided, and removed. The vein graft is then anastomosed in an end-to-side fashion to the inferior epigastric or femoral artery and tunneled to the base of the penis, where it is anastomosed to the corpus cavernosum using the same microsurgical technique.

3. Post-Procedure

Post-procedure care for patients undergoing penile revascularization typically involves monitoring for complications and ensuring proper healing. Patients are observed for signs of erection to confirm the success of the anastomosis. Additionally, instructions regarding activity restrictions, wound care, and follow-up appointments are provided to facilitate recovery. It is essential for patients to adhere to these guidelines to optimize healing and achieve the desired outcomes of the procedure.