CPT® Code 54417

Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

The procedure described by CPT® Code 54417 involves the removal and replacement of a penile prosthesis, which can be either non-inflatable (semi-rigid) or inflatable (self-contained), specifically performed through an infected surgical field during the same operative session. This complex surgical intervention is necessitated by the presence of infection, which requires careful handling of the prosthesis and surrounding tissues. The procedure begins with the placement of a catheter transurethrally to facilitate access and ensure proper drainage. The original incision used for the prosthesis insertion is reopened to allow for the exposure of the corpora cavernosa, the erectile tissues of the penis where the prosthesis is situated. Surgeons make longitudinal incisions along the dorsal surface of the corpora cavernosa to identify and access the cylinder implants. Each prosthesis, whether on the right or left side, is meticulously dissected free from the surrounding tissue and removed. In cases where the prosthesis is an inflatable semi-contained type, the tubing connected to the pump located in the sub-dartos pouch is also tracked, dissected, and removed. To manage any bleeding, hemostasis is achieved using electrocautery, and the wound is thoroughly irrigated with an antibiotic solution to minimize the risk of further infection. If the procedure is conducted through an infected field, additional care is taken to copiously irrigate the wound and debride any infected tissue as necessary. Following the removal of the infected prosthesis, a new penile prosthesis is then inserted. For non-inflatable semi-rigid prostheses, the length is measured, and appropriately sized prosthetic cylinders are loaded into an insertion device before being placed into the corporal spaces. The insertion device is subsequently removed, and the incision is closed in layers. In the case of self-contained inflatable prostheses, the replacement process involves similar steps, with the pump being inserted into the dartos pouch and connected to the cylinders. The device is then cycled to evaluate its function and check for any leaks before the corporal incisions are closed in layers. This procedure is critical for restoring function and addressing complications arising from infection.