CPT® Code 54304

Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps

The procedure described by CPT® Code 54304 involves a plastic operation on the penis aimed at correcting chordee or performing the first stage of hypospadias repair. Chordee is a condition characterized by a curvature of the penis, which can occur even when the glans (the tip of the penis) and the urethral meatus (the opening through which urine exits) appear normal. In such cases, the underlying issue often lies in the development of the urethral mucosa and spongiosum tissue, which may be thin and poorly developed, leading to the curvature. The surgical approach is staged, meaning that it may involve multiple procedures over time to achieve the desired outcome. During the operation, the surgeon aims to correct the curvature of the penis while also augmenting the urethra using an onlay island graft, which is a piece of tissue that is transplanted to enhance the urethral structure. The patient is typically positioned supine, and the surgical area is meticulously prepared and draped to maintain a sterile environment. The procedure begins with careful identification of the flat ventral surface of the glans, which is crucial for understanding the extent of the curvature. A vertical incision is made at the midline of the penis, which is then widened along the glanular groove to create an adequate meatal opening. This incision is intentionally left open to allow for epithelialization, which is the process of new skin forming over the wound. Subsequently, an incision is made in the subcoronal tissue surrounding the glans, with extensions on either side of the urethral plate where it connects to normal skin. This step is essential for accessing the underlying structures and facilitating the repair. The penile skin is then degloved, exposing Buck's fascia while preserving the vascular connection to the preputial flap, which is important for maintaining blood supply. The vascular pedicle is carefully separated from the outer preputial skin, ensuring that both layers retain their blood supply. An onlay flap is created from the inner prepuce, and running sutures are placed to draw the glans together, effectively correcting the curvature. Finally, the wing flaps are rotated medially around the newly formed urethra and approximated in the midline using mattress sutures, completing the surgical repair.