CPT® Code 51590

The procedure described by CPT® Code 51590 refers to a complete cystectomy, which is the surgical removal of the bladder, accompanied by the creation of a urinary diversion through either a ureteroileal conduit or a sigmoid bladder. This complex surgical intervention is typically indicated for patients with bladder cancer or other significant bladder pathologies that necessitate the complete removal of the bladder. The procedure involves an intraperitoneal approach, where the abdomen is incised in the midline to access the bladder and surrounding structures. Prior to the opening of the peritoneum, pelvic lymph nodes may be dissected to assess for any potential spread of disease. During the surgery, careful dissection is performed to preserve critical blood vessels and tissues, ensuring that the ureters, which transport urine from the kidneys to the bladder, are adequately mobilized. The choice between constructing a ureteroileal conduit or a sigmoid bladder depends on the specific surgical plan and patient needs. The procedure also includes the creation of a stoma, which is an opening on the abdominal wall through which urine will be expelled, and involves meticulous anastomosis of the ureters to the newly created urinary diversion. The entire process requires a thorough understanding of both surgical techniques and anatomical considerations to ensure successful outcomes and minimize complications.