toria11
Guru
Would you code this as 51845 or 57288? Thank you!!
Procedure Performed
Raz procedure with soft Prolene mess urethral sling
Type of Anesthesia
General
Indications
Severe stress incontinence
Findings
Stress incontinence
Technique/Description of Procedure
Patient was placed in the dorsal lithotomy position prepped and draped in the usual manner she had a Foley catheter inserted into her bladder. The periurethral tissue was grasped with Allis clamps 1 cm lateral to it. A parallel incisions were then made 1-1/2 cm from the distal urethra extending down to the bladder neck. We then created a tunnel submucosally twin the 2 incisions. Once this was done we then passed a Metzenbaum scissors into the retropubic space through the incision. We used our fingers to in large on each side. Once this was done a 12 cm by 1-1/2 cm soft Prolene mesh sling was positioned in the submucosal tunnel. We then passed the rods needle on the right-hand side through a puncture wound above the pubic symphysis and entered the vagina. We then placed a 0 Prolene suture in the sling. And transferred the sutures superiorly. Similar procedure was performed on the opposite side cystoscopy confirmed that there was no bladder perforation or damage to the urethra. We irrigated copiously with antibiotic solution. The mucosa was then closed with 2 0 Vicryl suture. We then tied the sutures over the rectus sheath on each side with the cystoscope in place to confirm no obstruction we nicely elevated the pelvic floor. The puncture wounds were closed with staples. Catheter was replaced cystoscopy confirmed no obstruction. Patient was transferred to recovery stable condition.
Procedure Performed
Raz procedure with soft Prolene mess urethral sling
Type of Anesthesia
General
Indications
Severe stress incontinence
Findings
Stress incontinence
Technique/Description of Procedure
Patient was placed in the dorsal lithotomy position prepped and draped in the usual manner she had a Foley catheter inserted into her bladder. The periurethral tissue was grasped with Allis clamps 1 cm lateral to it. A parallel incisions were then made 1-1/2 cm from the distal urethra extending down to the bladder neck. We then created a tunnel submucosally twin the 2 incisions. Once this was done we then passed a Metzenbaum scissors into the retropubic space through the incision. We used our fingers to in large on each side. Once this was done a 12 cm by 1-1/2 cm soft Prolene mesh sling was positioned in the submucosal tunnel. We then passed the rods needle on the right-hand side through a puncture wound above the pubic symphysis and entered the vagina. We then placed a 0 Prolene suture in the sling. And transferred the sutures superiorly. Similar procedure was performed on the opposite side cystoscopy confirmed that there was no bladder perforation or damage to the urethra. We irrigated copiously with antibiotic solution. The mucosa was then closed with 2 0 Vicryl suture. We then tied the sutures over the rectus sheath on each side with the cystoscope in place to confirm no obstruction we nicely elevated the pelvic floor. The puncture wounds were closed with staples. Catheter was replaced cystoscopy confirmed no obstruction. Patient was transferred to recovery stable condition.