In: Nursing
What are the ICD-10-PCS code for this?
PROCEDURE PERFORMED:
1. Right scrotal exploration, and right spermatocelectomy.
2. Left scrotal exploration and left orchiectomy.
INDICATIONS: This 55-year-old gentleman was admitted to this
Hospital approximately 4 months ago with bilateral testicular pain
and swelling and enlargement. Ultrasound revealed a cystic mass of
the right scxxtum consistent with right hydrocele. On the left
side, the patient had severe left epididymitis/orchitis that turned
to an abscess with spontaneous drainage. Subsequent ultrasounds
revealed essentially no vascular flow to the left testis and the
testis gradually became smaller, but it was painful to the patient.
The patient requested surgery because of pain in the left side and
because of enlargement of the right side, which he states
interfered with his sexual activity. The patient was advised that
following that spermatocelectomy on the right side, the patient
could have recurrence of the spermatocele/bleeding/infection and
pain.
DESCRIPTION OF PROCEDURE: After satisfactory general anesthesia,
the patient was prepped and draped in a supine position. An
incision was made in the midline of the scxxtum vertically. The
right testis was exposed and delivered from the incision. This was
done within the sac of the spermatocele. Spermatocele was
identified, being adherent to the right epididymis. There was
significant adherence and numerous small blood vessels present and
adherence of the spermatocele sac to both the testis and the
epididymis. Dissection was done sharply. The sac was excised, sent
to histology. Care was taken to preserve the blood supply to the
right testis. The small bleeding points were cauterized or suture
ligated. Hemostasis was also directed towards the scrotal wall.
Again, these were controlled by fulguration or suture ligature. The
testis was placed back into its anatomic position on the right
scrotal sac. A 5/8 Penrose nurse drain was left indwelling and
brought out a separate stab incision.
Attention was then directed to the left scrotal cavity where it was
incised, exposing the left testicle with much difficulty because of
the abscess formation the patient had. This required total sharp
dissection, which we also incurred some numerous bleeding points.
These were controlled by cauterization. Finally, the spermatic cord
was isolated. It was clamped and spermatic cord cut and the
testicle was then removed. The bleeding points were controlled with
ties of 2-0 Vicryl. Both scrotal cavities were irrigated
thoroughly. As on the right side, a Penrose drain was left
indwelling brought out separate stab incision, and then the wound
was closed with interrupted sutures of 3-0 chromic catgut. Sterile
dressings were applied as well as a scrotal support and the patient
taken to recovery room in good condition.