CPT® Code 51845

The CPT® Code 51845 refers to an abdomino-vaginal vesical neck suspension procedure, which is a surgical intervention aimed at addressing anatomical incontinence in women, particularly when this condition is associated with vaginal wall prolapse. This procedure is also known by various names, including the Stamey, Raz, or modified Pereyra procedures, and it can be performed with or without the assistance of endoscopic control. The primary goal of this surgery is to provide support to the bladder neck, thereby improving urinary continence. The procedure involves making incisions in both the abdominal and vaginal areas to access the necessary anatomical structures. The modified Pereyra technique specifically involves a transverse incision at the distal urethra and a vertical incision in the vagina, allowing for the dissection of the vaginal epithelium and exposure of the pubourethral ligaments. Heavy, nonabsorbable sutures are then utilized to secure these ligaments to the endopelvic fascia, which is crucial for restoring the anatomical position of the bladder. The Raz and Stamey procedures offer alternative approaches, each with distinct incision patterns and techniques for suspending the bladder. Overall, this procedure is a critical option for women suffering from incontinence due to pelvic support deficiencies, aiming to enhance their quality of life through improved bladder control.