CPT® Code 54390

1. Indications

The procedure described by CPT® Code 54390 is indicated for the surgical correction of epispadias that is distal to the external sphincter, particularly in cases complicated by bladder exstrophy. The following conditions warrant this surgical intervention:

• Epispadias: A congenital defect where the urethra opens on the top or side of the penis instead of at the tip.
• Bladder Exstrophy: A condition where the bladder is turned inside out and protrudes through the abdominal wall, often associated with epispadias.
• Bladder Neck and Sphincter Malformations: Complications that may arise from epispadias, necessitating surgical correction to restore normal urinary function.

2. Procedure

The surgical procedure for CPT® Code 54390 involves several detailed steps to effectively repair the epispadias and bladder exstrophy. The following procedural steps are performed:

• Step 1: A skin incision is made above the umbilicus, which is then carried around the sides of the bladder mucosa, stopping approximately 1 cm from the midline. The incision continues parallel along the distal urethral plate to the lateral region of the male verumontanum.
• Step 2: The incision is deepened around the umbilicus, and a plane is developed between the rectus muscle and the bladder wall. This dissection allows for better access to the bladder and surrounding structures.
• Step 3: The peritoneum is carefully dissected off the bladder and developed laterally until the trigone and the urogenital diaphragm are encountered, ensuring that the bladder is adequately mobilized for repair.
• Step 4: Ureteral stents are placed to facilitate urinary drainage during the healing process and to prevent complications.
• Step 5: The urogenital diaphragm is completely dissected off of the pubic bone, following the anatomy parallel to the bladder and posterior urethra, which is crucial for proper reconstruction.
• Step 6: Traction is applied to the pubic bone to bring the bladder neck deep into the pelvis, allowing for optimal positioning for closure.
• Step 7: The bladder neck and posterior urethra are closed, restoring the normal anatomy and function of the urinary tract.
• Step 8: An osteotomy is performed by bringing the pubic bone together in the midline using suture or wire, which is essential for stabilizing the pelvic structure.
• Step 9: Finally, the abdominal wall defect is closed in layers to ensure proper healing and to restore the integrity of the abdominal wall.

3. Post-Procedure

Post-procedure care following the surgical intervention for CPT® Code 54390 includes monitoring for complications such as infection, urinary retention, or issues related to the healing of the surgical site. Patients may require catheterization to facilitate urinary drainage during the initial recovery phase. The pelvis may be immobilized using traction, a cast, or an external fixator to ensure stability and proper healing of the surgical site. Follow-up appointments are essential to assess the healing process and to manage any potential complications that may arise during recovery.