CPT® Code 53520

The procedure described by CPT® Code 53520 involves the surgical closure of a urethrostomy or urethrocutaneous fistula in males, classified as a separate procedure. A urethrostomy is an opening created in the urethra, while a urethrocutaneous fistula is an abnormal connection between the urethra and the skin. This surgical intervention is necessary to restore normal anatomy and function by closing these openings. The procedure begins with the placement of a catheter through the urethra to maintain urinary drainage during the operation. A midline incision is made at the urethral opening on the penile skin, allowing access to the fistula or urethrostomy. The surgeon excises the epithelialized tissue of the fistula or urethrostomy, inverting the urethral mucosa to facilitate proper closure of the defect. The surgical technique involves extending the incision proximally towards the scrotum to visualize the underlying dartos muscle, which is essential for creating a robust closure. The scrotal skin is then undermined, and a flap is marked and excised from the dartos muscle, which is elevated and positioned over the closure site. This flap is secured with sutures, and the dartos muscle is approximated and sutured in place. A drain may be placed to prevent fluid accumulation, and the skin layers are closed without tension to ensure optimal healing. The Foley catheter remains in place postoperatively to assist with urinary drainage during recovery.