CPT® Code 54130

1. Indications

The procedure described by CPT® Code 54130 is indicated for the following conditions:

• Malignant Tumors The primary indication for this procedure is the presence of malignant tumors or lesions located on the penis that require radical surgical intervention.
• Penile Lesions Any significant lesions that may pose a risk of malignancy or have been diagnosed as cancerous necessitate this extensive surgical approach.

2. Procedure

The procedure consists of several critical steps to ensure the complete removal of the affected tissue and associated lymph nodes:

• Step 1: Tumor Isolation The surgical process begins with the isolation of the tumor or lesion using a sterile condom or glove that covers the entire penis. This step is crucial for maintaining a sterile field and preventing contamination during the procedure.
• Step 2: Incision and Dissection An elliptical incision is made at the base of the penis, extending through the subcutaneous tissue down to the pubis. This incision allows access to the underlying structures, where blood vessels and lymphatic tissues are carefully ligated or fulgurated to control bleeding.
• Step 3: Identification of Anatomical Structures The penile suspensory ligaments are identified and isolated. The dorsal vein and penile arteries are clamped and ligated to ensure complete vascular control before proceeding with the amputation.
• Step 4: Urethra Dissection The penis is positioned upward, and Buck's fascia is opened to dissect the urethra free from the corpora cavernosa. The urethra is then divided at the distal bulbar region, ensuring adequate length remains for routing to the perineum.
• Step 5: Amputation of Corpora Cavernosa The corpora cavernosa are dissected to the ischiopubic rami, where they are ligated and transected, completing the amputation of the penis.
• Step 6: Perineal Urethrostomy Dissection continues around the urethra to the urogenital diaphragm, aiming for a straight course to the perineal urethrostomy site. A wedge of skin and subcutaneous tissue is removed from the midline of the perineum, and a tunnel is created in the perineal subcutaneous tissue to pull the urethra through the incision.
• Step 7: Urethral Reconstruction After spatulating the urethra dorsally, a V-shaped skin inlay is created and anastomosed to the lining of the urethra. A catheter is inserted to maintain patency during the healing process.
• Step 8: Lymphadenectomy The procedure includes a bilateral inguinofemoral lymphadenectomy, where an incision is made parallel to the inguinofemoral ligament. Skin flaps are elevated, and deep tissues are dissected to identify and excise Cloquet's node, along with any nodal tissue, ensuring complete removal of potential malignancies.
• Step 9: Closure The groin and abdominal incisions are closed in layers, and Penrose drains are placed on either side of the scrotum to facilitate drainage and prevent fluid accumulation.

3. Post-Procedure

Post-procedure care involves monitoring for complications such as bleeding, infection, or issues related to the urethrostomy. Patients are typically advised to follow up with their healthcare provider for wound assessment and management of any drainage. Pain management and instructions for care of the perineal urethrostomy site are essential for recovery. The expected recovery period may vary based on individual patient factors and the extent of the surgery performed.