CPT® Code 51585

Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

The CPT® Code 51585 refers to a complete cystectomy procedure that includes the surgical removal of the bladder along with the creation of a urinary diversion, specifically through ureterosigmoidostomy or ureterocutaneous transplantation. This procedure is typically indicated for patients with severe bladder conditions, such as cancer, that necessitate the complete removal of the bladder. The surgical approach is intraperitoneal, meaning that the operation is conducted within the peritoneal cavity, which houses the abdominal organs. The procedure begins with a midline incision in the abdomen, allowing access to the pelvic region. Prior to entering the peritoneum, the surgeon dissects the pelvic lymph nodes, which may be necessary for staging or treatment of malignancies. The procedure also involves the meticulous dissection of fatty tissue surrounding the common iliac vessels and the excision of lymph nodes in the iliac, hypogastric, and obturator regions bilaterally. Following the opening of the peritoneum, the small bowel is temporarily moved out of the surgical field to expose the ureters, which are then mobilized and divided at the ureterovesical junction. A segment of the sigmoid colon is prepared to create a new pathway for urine drainage, and the ureters are anastomosed to this segment. The procedure concludes with the removal of the bladder and the closure of surgical incisions, ensuring that all necessary structures are addressed for optimal patient recovery and function.