CPT® Code 54420

The procedure described by CPT® Code 54420 involves a surgical intervention known as a corpora cavernosa-saphenous vein shunt, specifically aimed at treating priapism, a condition characterized by prolonged and often painful erections not associated with sexual desire. This operation can be performed unilaterally or bilaterally, depending on the clinical situation. The procedure entails the creation of a shunt between the corpora cavernosa, which are the two cylindrical structures in the penis that fill with blood during an erection, and the saphenous vein, a major vein located in the leg. The surgical approach begins with the placement of a Foley catheter transurethrally to facilitate drainage and manage the condition effectively. During the operation, an incision is made below the inguinal ligament at the saphenofemoral junction to access the saphenous vein. A segment of the vein, typically 8-10 cm in length, is mobilized for use in the shunt. A second incision is then made at the base of the penis to reach the corpora cavernosa. The tunica albuginea, a fibrous envelope surrounding the corpora cavernosa, is incised to allow for the connection of the harvested vein. The procedure may also involve irrigation of the penis and glans with a heparinized saline solution to clear any accumulated blood and clots, ensuring optimal conditions for the shunt. A tunnel is created between the two incisions, allowing the ligated saphenous vein to be brought through to the penile incision. The end of the vein is then spatulated and sutured to the elliptical incision in the tunica albuginea, establishing the shunt. After the connection is made, the incisions are closed in layers. If the initial unilateral procedure does not alleviate the pressure in the corpora cavernosa, a similar procedure may be performed on the opposite side to achieve the desired outcome. This detailed surgical approach is critical for effectively managing priapism and restoring normal penile function.