CPT® Code 51865

A cystorrhaphy is a surgical procedure specifically designed for the suture repair of a bladder wound, injury, or rupture. This procedure is indicated in cases where the bladder has sustained damage due to various types of injuries, which may include contusions that result in tears of the bladder mucosa, intraperitoneal lacerations or ruptures, interstitial injuries, extraperitoneal lacerations or ruptures, or a combination of these injury types. The complexity of the injury often dictates the need for a complicated cystorrhaphy, as opposed to a simpler suture repair. During the procedure, a Foley catheter is typically inserted to facilitate bladder drainage, ensuring that the surgical site remains clear of urine. The surgical approach involves making a vertical midline incision in the abdomen, allowing for thorough inspection of the pelvic viscera, ureters, bowel, and blood vessels. The exterior of the bladder is carefully examined, and the dome of the bladder is opened to inspect its interior. Any foreign bodies present are removed, and the ureteral orifices are checked for integrity. The specific bladder injury is then localized, and any nonviable tissue is debrided to promote optimal healing. The closure of the bladder injury is performed in layers, ensuring a watertight seal, and omental fat may be interposed to cushion the bladder from potential complications associated with pelvic fractures. After the closure, water or saline is instilled through the Foley catheter to confirm that there is no leakage at the repair site. In some cases, a suprapubic catheter may be placed through a separate incision, along with a drain in the perivesical space, to further manage the surgical site. The abdomen is subsequently closed in layers to complete the procedure. It is important to note that CPT® Code 51865 is used for complicated repairs, which may involve additional factors such as the presence of foreign bodies, debris, extensive nonviable tissue, or pelvic fractures that complicate the cystorrhaphy process.