CPT® Code 51820

Cystourethroplasty with unilateral or bilateral ureteroneocystostomy, as described by CPT® Code 51820, refers to a surgical procedure aimed at reconstructing the bladder and its associated structures. This procedure is particularly relevant for patients who have experienced congenital anomalies, scarring, or deformities resulting from previous surgeries or traumatic injuries. The term 'cystourethroplasty' indicates that the surgery involves plastic reconstruction of the bladder, which may also extend to the vesical neck and urethra. The choice of reconstruction technique is tailored to the specific condition being treated, ensuring that the surgical approach is appropriate for the patient's unique anatomical and pathological circumstances. To access the bladder, a surgical incision is typically made, which can be either a low midline or a transverse suprapubic incision. The approach to the bladder defect varies depending on its location; defects in the posterior bladder are generally approached intraperitoneally, while those in the dome, anterior bladder, vesical neck, and urethra are approached extraperitoneally. During the procedure, the bladder is incised to allow for inspection of the defect, and if necessary, portions of the bladder, bladder neck, or urethra may be excised. The reconstruction process may involve reconfiguring the bladder wall, such as plicating the bladder neck or performing a Y-plasty to address an enlarged bladder trigone. In the context of CPT® Code 51820, the procedure specifically addresses defects located near one or both ureteral orifices, necessitating a ureteroneocystostomy in conjunction with the cystourethroplasty. This involves ligating and transecting one or both ureters at the ureterovesical junction, followed by the repair of the bladder defect and the transplantation of the ureters to a new site within the bladder. The surgical technique includes creating a trough in the muscular wall of the bladder where the ureter(s) will be placed, followed by securing the ureter(s) to the bladder's interior with sutures and closing the trough over the proximal aspect of the ureter(s). This comprehensive approach aims to restore normal bladder function and anatomy, addressing the underlying issues that prompted the need for surgical intervention.