CPT® Code 54135

Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes

The procedure described by CPT® Code 54135 refers to a radical amputation of the penis performed in conjunction with a bilateral pelvic lymphadenectomy. This surgical intervention is typically indicated for the treatment of malignant tumors or lesions located in the penis. The procedure begins with the isolation of the tumor using a sterile condom or glove, which is then sutured at the base of the penis to contain the area of interest. An elliptical incision is made at the base, allowing access through the subcutaneous tissue to the pubis. During the surgery, blood vessels and lymphatic tissues are carefully ligated or fulgurated to prevent excessive bleeding. The penile suspensory ligaments are identified, and the dorsal vein along with the penile arteries are clamped and ligated to facilitate the amputation. The penis is positioned upward, and Buck's fascia is opened to dissect the urethra from the corpora cavernosa. The urethra is then divided at the distal bulbar region, ensuring sufficient length remains for routing to the perineum. The corpora cavernosa are dissected to the ischiopubic rami, where they are ligated and transected, completing the amputation. Further dissection is performed around the urethra to the urogenital diaphragm, aiming for a direct path to the perineal urethrostomy site. A wedge of skin and subcutaneous tissue is excised from the midline of the perineum, and a tunnel is created in the perineal subcutaneous tissue to pull the urethra through the incision. After spatulating the urethra dorsally, a V-shaped skin inlay is fashioned and anastomosed to the urethral lining. A catheter is then inserted, and Penrose drains are placed on either side of the scrotum. The wound is subsequently closed transversely to elevate the scrotum away from the perineal urethrostomy site. In cases where malignancy is detected in Cloquet's node, a bilateral pelvic lymphadenectomy is performed, which involves the excision of external iliac, hypogastric, and obturator nodes. The abdomen is incised without entering the peritoneum, allowing for exploration and excision of the pelvic lymph nodes, followed by layered closure of the groin and abdominal incisions. This comprehensive approach ensures thorough management of the malignancy while addressing the anatomical and functional aspects of the surgical site.