# Primary urethral realignment



## KFortygin (Apr 6, 2010)

Hi all,

I need to code a primary urethral realignment for injury of the prostatic urethra.
Physician performed cystoscopy, primary urethral realignment, pelvic exploration and bladder exploration on male patient.

*Here is description:*
We obtained two flexible cystoscopes and began our primary urethral realignment.  The first cystoscope was introduced through the cystotomy in the dome of the bladder and introduced down to the bladder neck and the second one was done with an assistant from below through the penis.  Under fluoroscopic guidance we were able to very carefully introduce the scopes adjacent to each other.  After the scopes were visualized on the monitor, a guidewire was inserted through the scope from above into the working channel from the scope from below.  

After this was done the scopes were withdrawn over the guidewire.  At this point in time we had through-and-through access through a cystotomy from the exploratory laparotomy wound from above and through the penis from below.  We obtained a 16-French Foley catheter and inserted this through the penis over the guidewire into the bladder.  

The inferior portion of the balloon was subsequently inflated in the Foley catheter and was palpably felt to be in place.  The bladder was subsequently opened via an extended vertical cystotomy.  The bladder was explored.  We had Anesthesia give the patient one ampule of indigo carmine dye.  The ureteral orifices were found and were found to be effluxing blue urine bilaterally.  Therefore our concern for a ureteral injury had now been put to rest.  We also explored the bladder neck.  There was no palpable defect in the bladder neck and none visually by our eyes.  The Foley catheter was indeed within the bladder and was visually in place.  

We next closed the bladder in two layers with running 4-0 Vicryl.  The first layer was done with mucosa and detrusor muscle.  This was run from above and below and tied in the middle.  The second layer was closed with 4-0 Vicryl as well.  At the completion of this the Foley catheter was irrigated and the bladder was found to be water tight.
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I am planning to use 51040, but then I am not sure where to head.

Can anyone help me with this?

Thank you!


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