CPT® Code 53240

1. Indications

The marsupialization of a urethral diverticulum is indicated for patients presenting with specific symptoms or conditions related to the diverticulum. These indications include:

• Urethral Diverticulum The primary indication for this procedure is the presence of a urethral diverticulum, which can cause urinary retention, recurrent urinary tract infections, or discomfort.
• Distal Urethral Location The procedure is specifically indicated when the diverticulum is located in the distal urethra, away from the bladder neck, allowing for effective surgical access and intervention.
• Suspicious Tissue If there is a need to inspect the diverticulum for suspicious-appearing tissue, a biopsy may be performed to rule out malignancy, necessitating the marsupialization procedure.

2. Procedure

The marsupialization procedure involves several critical steps to ensure successful treatment of the urethral diverticulum. Each step is designed to facilitate access to the diverticulum and promote proper healing.

• Step 1: Preparation The procedure begins with the placement of a transurethral catheter to empty the bladder. This step is crucial as it allows for a clear surgical field and reduces the risk of bladder injury during the procedure.
• Step 2: Incision After the bladder is emptied, the catheter is withdrawn. The surgeon then uses straight Mayo scissors to make an incision. One blade is placed in the urethra while the other is positioned along the anterior wall of the vagina. A midline incision is made beneath the posterior wall of the urethra to access the diverticular sac.
• Step 3: Inspection Once the diverticular sac is entered, the incision is enlarged as necessary to allow for thorough inspection of the diverticulum. The surgeon looks for any suspicious-appearing tissue that may require further evaluation.
• Step 4: Biopsy (if needed) If any suspicious tissue is identified, a biopsy may be performed. The tissue samples are prepared and sent for pathological examination as a separately reportable procedure.
• Step 5: Suturing Following inspection, the urethral and diverticular epithelial lining is sutured to the incised vaginal epithelial lining. This step exteriorizes the urinary tract epithelium and creates a large posterior meatotomy, facilitating better urinary flow.
• Step 6: Male Procedure In male patients with distal diverticula located close to the penile tip, a similar approach is taken. The diverticulum and meatus are opened together using a scalpel or scissors to form a single, large meatal opening.

3. Post-Procedure

After the marsupialization procedure, patients can generally expect spontaneous voiding, which indicates successful intervention. In most cases, a urinary catheter is not required post-operatively, allowing for a more comfortable recovery. Patients should be monitored for any signs of complications, such as infection or excessive bleeding, and follow-up care should be arranged to assess healing and urinary function.