In simple words: The surgeon corrects a previous unsuccessful surgery to repair a birth defect where the opening of the penis is not at the tip. This complex procedure involves extensive work, especially if multiple prior attempts have been made. The surgeon carefully dissects and removes tissue from the old repair, straightens the penis if curved, and rebuilds the urinary channel and penis using skin grafts and flaps. A catheter might be placed to help with urination.This is a major surgery requiring specialized expertise.

The provider revises repairs from previous hypospadias surgery. Hypospadias is a condition in which the urethral opening of the penis is abnormally located. These repairs require extensive work, as in the case of a patient who has undergone several failed repairs.The provider performs extensive dissection during the revision and excises (cuts out) structures, such as the urethra, constructed during previous surgeries. The provider re-releases the chordee, which is abnormal penis curvature. This may involve removing excess skin and tissue or making the longer and shorter sides of the penis equal in length. The provider reconstructs the urethra and penis using both local skin grafts and island flaps (such as from the glans, the tip) and other skin as flaps and grafts. The provider may correct urethral stricture by passing a catheter through the urethra and dilating the urethra. The provider also may create a urinary diversion, such as by placing a catheter into the patient’s bladder. The provider controls any bleeding and completes the procedure.

Example 1: A 6-year-old male presents with a history of two failed hypospadias repairs. The urethral meatus is located on the ventral shaft of the penis, and significant scarring is present. The surgeon performs code 54352 to revise the prior repair, utilizing local skin flaps and grafts to reconstruct the urethra and penis., A teenager has undergone multiple hypospadias repairs resulting in a "cripple" hypospadias with severe chordee. The surgeon performs extensive dissection and excision of previous scar tissue and reconstructs the urethra using an island flap and grafts. This complex case requires the expertise represented by code 54352., An adult male with a history of hypospadias repair experiences recurrent strictures and fistula formation.The surgeon performs a complex revision, excising the scarred urethra and reconstructing it with a combination of local flaps and skin grafts (54352).A temporary urinary diversion is created.

Operative report detailing the extent of the dissection, excision, the method of urethral reconstruction (including type of flaps and grafts used), and any additional procedures like chordee repair or urinary diversion. Pre-operative notes documenting the failed prior hypospadias repairs and the current anatomical abnormalities. Post-operative notes regarding wound healing and any complications.