CPT® Code 51940

Bladder exstrophy is a congenital condition characterized by a malformation where the bladder is flattened and positioned outside the body, rather than being contained within the abdominal cavity. This defect not only impacts the bladder but also involves the abdominal wall, pelvic bones, bladder neck, perineum, urethra, and external genitalia. In individuals with this condition, the abdominal wall is open, leading to a significant separation of the symphysis pubis at the midline, which is accompanied by bony deficits at the anterior pubic rami. Additionally, there is an anterior rotation of both the posterior and anterior aspects of the pelvis. The distance between the umbilicus and the anus is reduced due to the shortening and broadening of the perineum, which also affects the musculature at the bladder neck, resulting in difficulties with bladder control. In females, the anatomical alterations include a shorter urethra and vagina, along with widely separated labia and a bifid clitoris. In males, the penis may appear shorter than normal because its base remains attached to the pubic bones internally, a consequence of the failure of the pubic bones to fuse, which causes the base of the penis to spread apart. The surgical procedure coded as CPT® 51940 involves the closure of this exstrophy, beginning with the alignment of the pelvic bones. Depending on the degree of separation, techniques such as medial rotation of the greater trochanters or osteotomy may be employed to bring the pubic bones together. The procedure also entails closing the bladder, posterior urethra, and abdominal wall, which involves several intricate steps to ensure proper anatomical restoration and function.