CPT® Code 51565

Partial cystectomy is a surgical procedure that involves the removal of a portion of the bladder, typically performed to address localized malignant neoplasms within the bladder. This procedure is essential for patients diagnosed with bladder cancer, where the goal is to excise the tumor while preserving as much of the bladder as possible. The surgery is initiated by exposing the bladder through a low midline or transverse suprapubic incision, allowing the surgeon access to the bladder. Depending on the location of the tumor, the approach may vary; lesions located in the posterior bladder are generally accessed intraperitoneally, while those situated in the dome or anterior bladder are approached extraperitoneally. In cases where pelvic lymph node dissection is deemed necessary, this can be performed separately and is reported as a distinct procedure. Once the bladder is mobilized, stay sutures are placed at a distance from the lesion to facilitate a clear view of the area being treated. The bladder is then incised between these stay sutures, and the incision is enlarged to enhance visualization of the lesion. The excision involves removing the affected portion of the bladder along with surrounding perivesical fat and peritoneum, ensuring that a margin of healthy tissue is included to minimize the risk of cancer recurrence. After the lesion is excised, the bladder wall is reconstructed by closing the submucosa and muscle in layers. In addition to the partial cystectomy, CPT® Code 51565 includes ureteral re-implantation, which is necessary when the ureteral orifice must be sacrificed to achieve complete tumor removal. This involves selecting a site for re-implantation, creating a submucosal tunnel from the incision site to the new exit site for the ureter, and securing the ureter in place with sutures. This comprehensive approach ensures that the procedure not only addresses the malignancy but also maintains the functional integrity of the urinary system.