CPT® Code 53250

1. Indications

The excision of the bulbourethral gland (Cowper's gland) is typically indicated for various conditions that may affect the gland's function or structure. These indications may include:

• Benign Tumors - The presence of non-cancerous growths within or around the bulbourethral gland that may cause discomfort or other symptoms.
• Infection - Chronic or recurrent infections of the bulbourethral gland that do not respond to conservative treatment may necessitate surgical intervention.
• Abscess Formation - The development of an abscess in the gland, which can lead to pain and swelling, may require excision to prevent further complications.
• Malignancy - Suspected or confirmed cancerous lesions involving the bulbourethral gland that require removal to ensure complete excision of the tumor.

2. Procedure

The procedure for excising the bulbourethral gland involves several critical steps, each performed with precision to ensure successful outcomes. The first step is to make a horizontal curved incision in the skin of the perineum, positioned above the anal opening. This incision is carefully extended through the superficial layer of Camper's fascia, which is the fatty layer of tissue, and then through the deeper layer known as Colles' fascia, which provides structural support. Following this, the surgeon transects the rectus urethralis muscular band, which allows access into the urogenital diaphragm, a crucial area for the procedure.

Once access is achieved, the perirectal fascia, which forms the posterior layer of Denonvilliers' fascia, is identified and opened. This step is essential for locating the bulbourethral gland. The gland is then meticulously dissected free from the surrounding tissues to ensure complete removal. During this dissection, the ductal opening of the gland into the urethra is identified and ligated to prevent any leakage of glandular secretions into the urethra post-excision.

After the gland and the surrounding tissue are excised, they are thoroughly inspected for any abnormalities or signs of disease. If necessary, tissue samples may be prepared for pathological examination, which is a separate reportable procedure that can provide further insights into the nature of the excised tissue. Once the excision is complete, the incision site is closed in layers using absorbable sutures to promote healing. The skin edges are then approximated with interrupted sutures to ensure proper closure. In some cases, a Penrose drain may be left in place to facilitate drainage and prevent fluid accumulation at the surgical site.

3. Post-Procedure

Post-procedure care following the excision of the bulbourethral gland is crucial for ensuring proper recovery and minimizing complications. Patients are typically monitored for any signs of infection or excessive bleeding at the surgical site. Pain management is an important aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. It is also essential to provide instructions regarding wound care, including keeping the incision clean and dry to promote healing.

Patients may be advised to avoid strenuous activities and heavy lifting for a specified period to prevent strain on the surgical site. Follow-up appointments are usually scheduled to assess healing and to remove any sutures if non-absorbable materials were used. If a Penrose drain was placed, it will be monitored and removed as necessary based on the amount of drainage and the surgeon's assessment. Overall, adherence to post-procedure instructions is vital for a smooth recovery and to ensure the best possible outcomes following the excision of the bulbourethral gland.