CPT® Code 53420

The procedure described by CPT® Code 53420 refers to a urethroplasty, specifically the first stage of a two-stage reconstruction or repair of the prostatic or membranous urethra. This surgical intervention is typically indicated for patients who have sustained injuries or trauma to the urethra, which may occur due to various factors such as pelvic fractures, prostate surgeries, or radiation therapy. The prostatic and membranous urethra are critical components of the urinary tract, extending from the bladder neck through the prostate gland and terminating at the bulbar segment. In this first stage of the procedure, a perineal approach is utilized, which involves making a midline incision in the perineal area. The surgical team dissects through the bulbospongiosum muscle to expose the corpus spongiosum and locate the urethra. If a stricture is present, the urethra is opened and resected to access healthy tissue at both ends. In cases of complete transection, the distal and proximal ends of the urethra are identified and brought together at the midline. A buccal mucosal graft, which has been prepared in advance, is then used to line the urethral defect or encase the urethral stumps. The graft is sutured to the edges of the perineal skin and around the urethral stumps, while urine is diverted through a suprapubic catheter that is typically not left in place after this stage. This initial stage sets the foundation for the subsequent second stage of the procedure, which is performed once the graft has adequately vascularized and epithelial tissue is observed at the perineum.