CPT® Code 50825

Continent diversion, including intestine anastomosis using any segment of small and/or large intestine (Kock pouch or Camey enterocystoplasty)

A continent urinary diversion procedure, as described by CPT® Code 50825, involves the surgical creation of a new pathway for urine to exit the body while allowing the patient to maintain some control over urination. This procedure is distinct from other forms of urinary diversion because it enables the patient to void through the urethra normally or through a stoma that incorporates a valve mechanism. The valve mechanism is designed to prevent urine leakage, allowing the patient to manage their urinary output by catheterizing the pouch at regular intervals. The surgical approach typically involves a midline incision in the abdomen, through which the small bowel is isolated and temporarily moved out of the surgical field. The ureters, which carry urine from the kidneys to the bladder, are carefully exposed, mobilized, and divided near their junction with the bladder. The procedure includes the ligation of the ureteral stumps and the selection of a segment of small or large intestine, usually measuring 30-35 cm, to construct the urinary pouch. This segment is meticulously isolated while preserving its blood supply, and the remaining portions of the intestine are reconnected to restore bowel continuity. The isolated intestinal segment is then shaped into a pouch, which may involve detubularization and the creation of a tunnel for the ureters to connect to the pouch. Depending on the patient's anatomy and needs, the pouch may be anastomosed to the bladder neck in females or the proximal urethra in males, or a stoma may be created. If a stoma is formed, a valve mechanism is constructed to facilitate urine retention and controlled release. Throughout the procedure, careful attention is paid to the surgical technique to ensure proper function and minimize complications.