CPT® Code 54332

1. Indications

The procedure described by CPT® Code 54332 is indicated for the surgical correction of proximal penile or penoscrotal hypospadias. The following conditions warrant this surgical intervention:

• Proximal Hypospadias - A condition where the urethral opening is located in the penoscrotal region, which may lead to difficulties with urination and potential complications in sexual function.
• Chordee - A curvature of the penis that can accompany hypospadias, necessitating correction to ensure proper anatomical alignment and function.
• Cosmetic Concerns - Patients or guardians may seek surgical intervention for aesthetic reasons, aiming to achieve a more typical appearance of the penis.

2. Procedure

The surgical procedure for CPT® Code 54332 involves several detailed steps to effectively repair proximal hypospadias and correct associated chordee:

• Step 1: Incision - A Y-shaped incision is made in the glans penis, with the long vertical segment extending down to the coronary sulcus. This incision allows access to the underlying structures and facilitates the necessary dissection.
• Step 2: Dissection and Excision - The surgeon identifies and excises fibrotic tissue from the midline and laterally to correct the chordee. This step is crucial for restoring the normal curvature of the penis.
• Step 3: Flap Elevation - Three glans flaps are elevated to create space for the neo-urethra. This elevation is performed carefully to preserve the surrounding tissue and ensure adequate blood supply.
• Step 4: Skin Flap Creation - A long rectangular skin flap is created, which includes a small cuff of skin containing the urethral meatus. The incision is made proximally in the midline of the scrotum, extending distally and laterally to the prepuce if necessary.
• Step 5: Mobilization of Penile Skin - The penile skin is elevated and mobilized dorsally down to the root of the penis, taking care to avoid any rotation of the flap that could compromise its viability.
• Step 6: Tubularization of the Flap - The flap is tubularized over a catheter or stent, with suturing performed from distal to proximal using a continuous subcuticular stitch. This step is essential for forming the new urethral channel.
• Step 7: Creation of Neo-Meatus - The terminal end of the neo-urethra is sutured to the ventral V-shaped incision in the glans, establishing the new urinary opening.
• Step 8: Glanular Wing Approximation - A slit-like opening and a conical glans are achieved by excising a small V-shaped tip in the neo-urethra. The glanular wings are then wrapped around the neo-urethra distally and approximated in the midline.
• Step 9: Reinforcement - A layer of vascular areolar subcutaneous tissue is placed as reinforcement over the tubularized graft to enhance stability and support.
• Step 10: Closure - The skin is approximated in the midline to simulate the normal penile raphae and is closed with a continuous transverse mattress stitch, ensuring a secure and aesthetically pleasing result.

3. Post-Procedure

Post-procedure care following the hypospadias repair involves monitoring for complications such as infection, bleeding, or issues with the newly formed urethra. Patients may be advised to avoid strenuous activities and to follow specific guidelines regarding hygiene and catheter care if a stent is placed. Follow-up appointments are essential to assess healing and the functionality of the neo-urethra, ensuring that the surgical goals have been met and that the patient is recovering appropriately.