CPT® Code 51925

The procedure described by CPT® Code 51925 involves the surgical closure of a vesicouterine fistula in conjunction with a hysterectomy. A vesicouterine fistula is an abnormal connection between the bladder and the uterus, which can lead to significant complications such as urinary incontinence and recurrent urinary tract infections. The surgical approach begins with an incision in the lower abdomen, allowing the physician to inspect the abdominal cavity and pelvis thoroughly. The vesicouterine space is then carefully dissected using both sharp and blunt dissection techniques to locate the fistulous tract. Once identified, the tract is excised, and the openings in both the bladder and uterus are meticulously closed. To ensure proper healing and prevent future complications, omentum—a fold of peritoneum—may be interposed between the bladder and uterus. The integrity of the bladder repair is confirmed by filling the bladder retrograde, ensuring a watertight closure. Following the closure of the bladder and uterus, the procedure transitions to a hysterectomy, where the uterus and cervix are removed. This involves identifying and ligating the infundibulopelvic and round ligaments, reflecting the bladder away from the cervix, and managing the uterine and cervical vessels. The vaginal cuff is then closed, and the abdominal incision is closed in layers to promote optimal healing. This comprehensive approach addresses both the fistula and the underlying need for a hysterectomy, ensuring a thorough resolution of the patient's condition.