Circumsion, repair buried penis, penoscrotal web, penile detorsion, etc.


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Can I get some imput on the following op note:

Post op dx. buried penis, penoscrotal web, penile torsion, & phimosis

Operation: Repair buried penis, Repair penoscrotal web, penile detorsion, circumsion, byar's flaps, urethral catheterization

Here is the scrub:

.. glanular adhesions were release & the smegma removed. A buried penis, penoscrotal web, penile torsion & phimosis were noted. His meatus was noted @ the tip of the penile glans.
A french catheter was inserted into the urethra. The cath was left in place until reapproximation of the penile skin. The cath was removed. The penis was then superficially degloved. Penopubic fixation was then performed by using a single suture @ the 12 oclock position of the dorsal aspect of the penile shafts subcutaneous tissue (superficial to Bucks fascia) to the corresponding position of the pubic fascia. Penoscrotal fixation was then performed with suture @ 5 oclock & 7oclock portions of the ventral aspect of the base of the penile shafts subcutaneous tissue (superficial to bucks fascia) to the corresponding positions of the scrotums subcutaneous tissue. Penoscrotal fixation helped correct the buried penis but also the penoscrotal web.

... the penis was then minimally rotated in a clockwise direction to orient the meatus vertically. The penile skin was then rotated with byar flaps from dorsally to ventrally for skin coverage & to eliminate the redundant penile skin. The redundant penile skin along with the phimotic ring of tissue was excised. At the end of proc. the penis was straight w/out chordee or torsion.

The distal most portion of the reconstructed penile skin was then brought to the circumferential mucosal collar & was then approximated to the mucosal collar with sutures.

I was going to use 54360, 54161, 14040, 51701

Any imput would be appreciated much.