urethroplasty is the definitive surgical reconstruction or repair of the urethra, typically performed to restore normal urinary flow in patients with debilitating urethral strictures, traumatic urethral disruptions, or congenital anomalies such as hypospadias. Unlike a urethrotomy or urethral dilation, which merely incise or stretch the scar tissue endoscopically and have high recurrence rates, urethroplasty involves open surgical excision of the fibrotic segment or augmentation of the urethral lumen. The procedure is broadly categorized by its underlying physiological mechanism of repair into anastomotic urethroplasty (excision of the stricture and primary end-to-end anastomosis of healthy tissue) and substitution urethroplasty (using tissue transfers, such as buccal mucosa grafts or genital skin flaps, to widen the strictured segment). It is primarily a treatment for pathological conditions like post-infectious or post-traumatic strictures (N35.114, N35.014), but is also used for congenital physiological defects (Q54.x). urethroplasty is commonly confused with urethrotomy; the key difference is that urethrotomy is an endoscopic incision of a stricture without tissue removal or grafting, whereas urethroplasty is an open, reconstructive tissue repair.
Urethroplastic(adjective form — e.g., “urethroplastic reconstruction,” “urethroplastic flap”)
Urethral reconstruction(lay and clinical term; frequently used in urology and reconstructive pelvic surgery)
Excision and Primary Anastomosis (EPA)(define briefly — removal of the strictured urethral segment with direct end-to-end reconnection of the healthy stumps; typically used for short bulbar strictures)
Substitution urethroplasty(clinical synonym used when the stricture is too long for EPA, requiring a graft or flap to augment the urethral lumen)
Buccal Mucosa Graft (BMG) urethroplasty(specific substitution technique utilizing tissue harvested from the inner cheek; highly successful due to the graft’s resistance to stricture)
Johanson procedure(a classic two-stage urethroplasty technique, often used for complex or salvage cases)
Anterior urethroplasty(anatomic subtype — repair of the penile or bulbar urethra; coded under 53410)
Posterior urethroplasty(anatomic subtype — repair of the membranous or prostatic urethra, often post-pelvic fracture; coded under 53415 or 53420-53425)
đź”— RELATED TERMS
urethrotomy — the opposite/alternative to urethroplasty; an endoscopic procedure (DVIU) that cuts the stricture with a cold knife or laser rather than reconstructing the tissue, carrying a higher recurrence rate.
Urethropexy — shares the urethro- root; surgical suspension or fixation of the urethra, typically performed for stress urinary incontinence rather than stricture disease.
Urethral stricture — abnormal narrowing of the urethral lumen due to fibrosis and scarring; the primary pathological diagnosis necessitating urethroplasty (N35.x).
Hypospadias — congenital anomaly where the urethral meatus opens on the ventral surface of the penis; repair requires complex urethroplasty techniques (Q54.x).
Tissue transfer — the physiological mechanism of moving healthy tissue (graft or flap) with or without its own blood supply to augment the narrowed urethral plate.
Ischemic — adjective describing poor blood supply to the urethra, which causes spongiofibrosis and stricture formation, necessitating excision during repair.
Spongiofibrosis — pathological cellular mechanism involving dense collagen deposition in the corpus spongiosum, replacing healthy vascular tissue and causing strictures.
Urethral diverticulum — localized outpouching of the urethral mucosa;excision and reconstruction of the urethra is often required (N32.1).
Retrograde urethrogram — primary diagnostic radiological procedure (RUG) used to evaluate the location, length, and severity of a urethral stricture prior to urethroplasty.
Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less (Used for Buccal Mucosa Graft harvest)
Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female
Cystourethroscopy with direct vision internal urethrotomy
⚠️ Coding Note: For inpatient profee urology coding, precise identification of the stricture’s anatomic location (anterior vs. posterior/membranous) and the staging of the procedure (1-stage vs. 2-stage) is critical for accurate CPT selection. A common undercoding error in substitution urethroplasties is failing to separately report the harvest of a buccal mucosa graft; CPT 15240 (Full thickness graft, mouth) should be coded in addition to the primary urethroplasty code (e.g., 53410) unless the graft is harvested by a separate surgeon (e.g., ENT), in which case the urologist only codes the urethroplasty and the ENT codes the harvest. Always verify the etiology of the stricture in the documentation (post-traumatic, post-infectious, or iatrogenic) to ensure the highest specificity for the N35.- ICD-10-CM code, as unspecified codes (N35.9-) may trigger medical necessity denials from Noridian MAC. If a suprapubic catheter is placed during the procedure, check NCCI edits, as it is often bundled into the primary reconstruction unless performed via a separate approach or distinct indication.