pvacanti
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And here is the 2nd stage hypospadias for the same patient. Looking for coding suggestions.. Thanks!
PREOPERATIVE DIAGNOSIS
Proximal hypospadias, status post first stage of planned 3-stage repair.
POSTOPERATIVE DIAGNOSIS
Proximal hypospadias, status post first stage of planned 3-stage repair.
PROCEDURES
1. Excision of scar for penile straightening.
2. Perineal urethrostomy.
3. Preputial skin graft harvest.
4. Circumcision.
5. Complex catheterization.
OPERATIVE DETAILS
ANESTHESIA: General plus caudal.
ESTIMATED BLOOD LOSS: 10 mL.
SPECIMENS: None.
DRAINS: 6-French urethral catheter.
DISPOSITION: Stable to postanesthesia care unit.
FINDINGS
1. Mid scrotal hypospadias.
2. 30 degrees of residual ventral penile curvature, which corrected following placement of a single dorsal plicating suture.
3. 1.5 x 4.5 cm graft.
4. Perineal meatus following completion of procedure.
INDICATIONS FOR PROCEDURE
The patient is a 12-month-old male with a history of a perineal hypospadias. He previously underwent a first stage of a planned 3-stage repair and today presented for his second-stage procedure.
DESCRIPTION OF PROCEDURE
After the appropriate legal consent was obtained, the patient was brought to the main OR at Helen DeVos Children's Hospital. He was placed in supine position on the operating room table. General as well as caudal anesthetic was administered per Anesthesiology Service. The patient's genitals were then prepped and draped in standard sterile fashion. A traction suture was then placed in the glans
penis as well as each edge of the incomplete prepuce. The patient's meatus was located in the mid shaft of the scrotum that was widely patent. A Y-shaped incision was then marked extending along each of the edges of the incomplete prepuce and then ventrally down the midline and around the urethral meatus. The area of incision was infiltrated with dilute epinephrine and cut. The ventrum of the penis was then degloved and all aberrant dartos tissue was carefully excised. An artificial erection was then administered. The patient was noted to have 30 degrees of residual ventral penile curvature. Given the slight curvature, the distal circumcising incision was made and the dorsum of the penis was then degloved. A single dorsal plicating suture was then placed using nonabsorbable suture. Repeat artificial erection revealed a straight phallus.
With the phallus then straightened, the dartos tissue was carefully excised from the penile shaft skin and the prepuce. The graft was then marked, carefully excised, and set aside for later use. The glans wings were then infiltrated with dilute epinephrine and cut. The atretic urethra was then carefully excised and the glans wings were mobilized widely. The proximal and distal aspects of the circumcision were then joined using absorbable suture in an interrupted fashion. With the circumcision then completed, the perineal urethrostomy was matured using absorbable suture. With the perineal urethrostomy then matured, the previously harvested graft was placed over the ventral defect. The inner prepuce was placed distally into the glans. The graft was secured peripherally using absorbable suture in interrupted fashion. The graft was buttonholed and secured around the native urethra as well. Quilting sutures were then placed using absorbable suture in interrupted fashion. Following placement of the quilting sutures, a 6-French urethral catheter was then placed and secured in place. A tie-down gauze with bolster was secured over the graft to prevent hematoma formation beneath the graft. Throughout the case, meticulous hemostasis was achieved via a combination of electrocautery and topical epinephrine. Standard dressings were applied. The patient tolerated the procedure without apparent complication. He was taken in stable condition to postanesthesia care unit for brief postoperative convalescence prior to his anticipated discharge to home.
PREOPERATIVE DIAGNOSIS
Proximal hypospadias, status post first stage of planned 3-stage repair.
POSTOPERATIVE DIAGNOSIS
Proximal hypospadias, status post first stage of planned 3-stage repair.
PROCEDURES
1. Excision of scar for penile straightening.
2. Perineal urethrostomy.
3. Preputial skin graft harvest.
4. Circumcision.
5. Complex catheterization.
OPERATIVE DETAILS
ANESTHESIA: General plus caudal.
ESTIMATED BLOOD LOSS: 10 mL.
SPECIMENS: None.
DRAINS: 6-French urethral catheter.
DISPOSITION: Stable to postanesthesia care unit.
FINDINGS
1. Mid scrotal hypospadias.
2. 30 degrees of residual ventral penile curvature, which corrected following placement of a single dorsal plicating suture.
3. 1.5 x 4.5 cm graft.
4. Perineal meatus following completion of procedure.
INDICATIONS FOR PROCEDURE
The patient is a 12-month-old male with a history of a perineal hypospadias. He previously underwent a first stage of a planned 3-stage repair and today presented for his second-stage procedure.
DESCRIPTION OF PROCEDURE
After the appropriate legal consent was obtained, the patient was brought to the main OR at Helen DeVos Children's Hospital. He was placed in supine position on the operating room table. General as well as caudal anesthetic was administered per Anesthesiology Service. The patient's genitals were then prepped and draped in standard sterile fashion. A traction suture was then placed in the glans
penis as well as each edge of the incomplete prepuce. The patient's meatus was located in the mid shaft of the scrotum that was widely patent. A Y-shaped incision was then marked extending along each of the edges of the incomplete prepuce and then ventrally down the midline and around the urethral meatus. The area of incision was infiltrated with dilute epinephrine and cut. The ventrum of the penis was then degloved and all aberrant dartos tissue was carefully excised. An artificial erection was then administered. The patient was noted to have 30 degrees of residual ventral penile curvature. Given the slight curvature, the distal circumcising incision was made and the dorsum of the penis was then degloved. A single dorsal plicating suture was then placed using nonabsorbable suture. Repeat artificial erection revealed a straight phallus.
With the phallus then straightened, the dartos tissue was carefully excised from the penile shaft skin and the prepuce. The graft was then marked, carefully excised, and set aside for later use. The glans wings were then infiltrated with dilute epinephrine and cut. The atretic urethra was then carefully excised and the glans wings were mobilized widely. The proximal and distal aspects of the circumcision were then joined using absorbable suture in an interrupted fashion. With the circumcision then completed, the perineal urethrostomy was matured using absorbable suture. With the perineal urethrostomy then matured, the previously harvested graft was placed over the ventral defect. The inner prepuce was placed distally into the glans. The graft was secured peripherally using absorbable suture in interrupted fashion. The graft was buttonholed and secured around the native urethra as well. Quilting sutures were then placed using absorbable suture in interrupted fashion. Following placement of the quilting sutures, a 6-French urethral catheter was then placed and secured in place. A tie-down gauze with bolster was secured over the graft to prevent hematoma formation beneath the graft. Throughout the case, meticulous hemostasis was achieved via a combination of electrocautery and topical epinephrine. Standard dressings were applied. The patient tolerated the procedure without apparent complication. He was taken in stable condition to postanesthesia care unit for brief postoperative convalescence prior to his anticipated discharge to home.
