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Official Description

Sling operation for correction of male urinary incontinence (eg, fascia or synthetic)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The sling operation for the correction of male urinary incontinence is a surgical procedure designed to provide support to the urethra, thereby reducing or eliminating involuntary leakage of urine. This procedure utilizes a graft, which can be made from various materials including allograft (tissue from a donor of the same species), xenograft (tissue from a donor of a different species), or synthetic mesh. The primary goal of the sling operation is to create a supportive structure beneath the urethra, which helps to maintain its position and function, particularly during activities that increase abdominal pressure, such as coughing, sneezing, or exercising. The procedure involves several key steps, including the insertion of a Foley catheter to facilitate access and drainage, making incisions to expose the necessary anatomical structures, and carefully placing the sling material to ensure optimal support. The operation is performed through a combination of suprapubic and perineal incisions, allowing the surgeon to access the retropubic space and accurately position the sling. The careful adjustment of tension on the sling is crucial to ensure that it provides adequate support without causing obstruction to the urethra, thus promoting urinary continence postoperatively.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The sling operation for correction of male urinary incontinence is indicated for patients experiencing involuntary leakage of urine due to conditions such as:

  • Male Urinary Incontinence - A condition characterized by the involuntary loss of urine, which can significantly impact quality of life.

2. Procedure

The procedure involves several detailed steps to ensure the successful placement of the sling for urinary support:

  • Step 1: A Foley catheter is inserted transurethrally to facilitate urinary drainage and access during the procedure.
  • Step 2: A transverse suprapubic incision is made to expose the rectus fascia, which is then incised to allow access to the retropubic space.
  • Step 3: A U-shaped perineal incision is created in the skin, extending through the bulbospongiosum muscle down to the corpus spongiosum, allowing for further dissection.
  • Step 4: Dissection continues until the urethra is identified, and the retropubic space is accessed on both sides of the urethra.
  • Step 5: A ligature passer is inserted into the retropubic space through the suprapubic incision, perforating the endopelvic fascia and exiting through the perineal incision on one side of the urethra.
  • Step 6: A sling graft is placed under the urethra, with one end attached to the ligature passer, which is then pulled through the endopelvic fascia into the retropubic space.
  • Step 7: The graft is detached from the ligature passer, which is then passed again through the suprapubic incision and endopelvic fascia, exiting on the opposite side of the urethra.
  • Step 8: The other end of the sling graft is attached to the ligature passer and pulled into the retropubic space, seating the sling under the urethra.
  • Step 9: The tension of the sling is adjusted to provide adequate support without obstructing the urethra.
  • Step 10: The perineal wound is closed, and the sling sutures are tunneled through the rectus fascia.
  • Step 11: The rectus fascia is closed, and the sling sutures are tied down over the closed fascia, followed by the closure of the suprapubic fascia.
  • Step 12: Alternatively, the graft may be secured to the pubic rami using a bone drill, where three screws with sutures are driven into each side of the pubic rami, securing the graft material to the bone.
  • Step 13: The tension on the sling is adjusted, and the sutures are securely tied before closing the incision in layers.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring proper healing of the surgical sites. Patients may be advised on activity restrictions and the importance of follow-up appointments to assess the effectiveness of the sling and any potential need for further intervention. Pain management and care of the incision sites are also critical components of post-operative care to promote recovery and minimize discomfort.

Short Descr MALE SLING PROCEDURE
Medium Descr SLING OPRATION CORRJ MALE URINARY INCONTINENCE
Long Descr Sling operation for correction of male urinary incontinence (eg, fascia or synthetic)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1
CCS Clinical Classification 106 - Genitourinary incontinence procedures
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GC This service has been performed in part by a resident under the direction of a teaching physician
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
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2003-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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