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Yadav P, Bobrowski A, Ahmad I, Kim JK, Chancy M, Alshammari D, Rickard M, Lorenzo AJ, Bagli D, Chua ME. A scoping review on chordee correction in boys with ventral congenital penile curvature and hypospadias. Indian J Urol 2024; 40:17-24. [PMID: 38314084 PMCID: PMC10836453 DOI: 10.4103/iju.iju_277_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Congenital penile curvature (PC), often concomitant with hypospadias, poses challenges in urology. Surgical correction techniques, including plication and corporotomy, lack standardized guidelines. This study aims to address the paucity of high-level evidence by comprehensively reviewing the outcomes of PC correction procedures in patients with and without hypospadias. This will inform clinical decision-making and provide insights for future research and meta-analyses. Methods We conducted this scoping review in accordance with the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines. An extensive literature search was performed and comparative studies published in English up to June 2023 were included. The studies were divided into three categories: PC without hypospadias, PC with hypospadias, and studies comparing two or more materials for covering the ventral corporotomy. Data extraction comprised author details, patient characteristics, study design, interventions, outcomes, and complications. Methodological quality was assessed using the Newcastle-Ottawa Scale. Results Forty-two studies were included in the review, which collectively comprised 3180 patients. Thirteen comparative studies reported the outcomes of surgery for congenital PC without hypospadias, 22 studies compared different techniques of PC correction in patients with hypospadias and 7 studies compared the type of materials for coverage following ventral corporotomy. In cases of PC without hypospadias, the most commonly reported surgery was the Nesbit's plication. For PC with hypospadias correction, the results of ventral corporotomy were superior to that of dorsal plication in most of the studies. The two-stage repair had better results when compared to the one-stage repair for patients with perineo-scrotal hypospadias. In studies comparing materials for coverage of ventral corporotomy, the tunica vaginalis flap or graft was utilized most commonly. The majority of the studies reported a success rate ranging from 85% to 100%. The methodological quality was high in all but four studies. Conclusion Plication procedures are generally preferred for PC without hypospadias, but they result in penile shortening. For those with hypospadias, corporotomy is associated with superior outcomes than plication, especially for those with severe curvature and redo procedures. For ventral corporotomy coverage, the tunica vaginalis flap or graft is the most commonly reported tissue in the literature.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Adam Bobrowski
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Ihtisham Ahmad
- Department of Undergraduate Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Margarita Chancy
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Dheidan Alshammari
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Darius Bagli
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- Department of Urology, Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
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Zhou G, Yin J, Sun J, Liu X, Su J, Li S. Urethroplasty for chordee with a paper‐thin hypoplastic urethra: A long‐term study. Int J Urol 2022; 29:656-660. [PMID: 35306690 PMCID: PMC9544243 DOI: 10.1111/iju.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Objectives To establish a standard surgical procedure for children with chordee with a paper‐thin hypoplastic urethra, which was based on the degree of curvature and urethral plate quality. To guidelines for the management of this disorder. Methods We reviewed 58 cases of chordee with a paper‐thin hypoplastic urethra, managed between March 2006 and September 2020. The age of the patients ranged from 23 to 89 months. Operative details and postoperative complications were analyzed. Results Mild‐moderate chordee with a paper‐thin hypoplastic urethra correction was performed using a tubularized incised plate (13 cases) or onlay island flap (five cases) technique after penile degloving. Severe chordee with a paper‐thin hypoplastic urethra required transection of the urethra and underwent a Duckett (11 cases) or staged (29 cases) urethroplasty. Complications in the tubularized incised plate and onlay island flap groups were 7.7% and 20%, respectively. The overall complication rate was 10.3% in the staged group and 27.3% in the Duckett group. Conclusions Reconstruction of the entire hypoplastic urethra should be recommended in the management of chordee with a paper‐thin hypoplastic urethra. We propose an algorithm based on the degree of curvature and urethral plate quality. The tubularized incised plate or onlay island flap technique can be used for mild to moderate chordee with a paper‐thin hypoplastic urethra, and the outcome of the tubularized incised plate technique tends to be better than that of the onlay island flap technique. Duckett or staged urethroplasty is suitable for severe chordee with a paper‐thin hypoplastic urethra, and the staged technique can improve the overall success rate.
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Affiliation(s)
- Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
| | - Jianchun Yin
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
| | - Junjie Sun
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
| | - Xiaodong Liu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
| | - Jiahong Su
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children’s Hospital Shenzhen Guangdong China
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Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Tarmono T, Utomo T, Yuri P, Siregar S, Wahyudi I, Situmorang GR, Palinrungi MAA, Hutasoit YI, Hutahaean AYA, Zulfiqar Y, Sigumonrong YH, Mirza H, Rodjani A. Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals. Open Access Maced J Med Sci 2019; 7:2242-2245. [PMID: 31592011 PMCID: PMC6765069 DOI: 10.3889/oamjms.2019.628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Hypospadias is the second most common congenital anomalies among human congenital disabilities. There are over 300 surgery techniques being introduced to treat hypospadias. The successful of hypospadias repair is assessed by several outcomes as well as complications following surgery. AIM: This study aims to show the multicenter hypospadias data in Indonesia descriptively. METHODS: All the data were compiled based on questionnaires, which were distributed to Indonesian pediatric urologists. The questionnaire includes several questions containing demographic aspect, preferred techniques being used, and complications being found regarding hypospadias repair. RESULTS: Eighteen Indonesian pediatric urologists from 12 centres involved in this study. The data were collected from June – September 2018 based on the surgeon’s experience throughout 2017. From 591 cases based on the returned questionnaire, penile-type hypospadias was the most common type of hypospadias being treated (35.7%) followed by penoscrotal (28.9%) and scrotal-type (12.9%). Moderate severity of chordee was mostly seen among all cases (40.6%). Tubularised incised plate (TIP), + Thiersch Duplay, was the most common technique being used to treat hypospadias (44.3%), followed by onlay island preputial flap (14.9%) and two-stage technique (14%). The incidence of urethrocutaneous fistulae in this study was 13.9%. CONCLUSION: This study showed how Indonesian pediatric urologists dealt with hypospadias cases. TIP + Thiersch Duplay procedure being the preferred technique used by most participants and the rate of urethrocutaneous fistulae as one of the complications was comparable with previous studies.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Divison of Urology, Department of Surgery, Faculty of Medicine Universitas Udayana, Sanglah Hospital, Denpasar, Indonesia
| | - Pande Made Wisnu Tirtayasa
- Divison of Urology, Department of Surgery, Faculty of Medicine Universitas Udayana, Sanglah Hospital, Denpasar, Indonesia
| | - Besut Daryanto
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia
| | - Pradana Nurhadi
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Tarmono Tarmono
- Department of Urology, Faculty of Medicine Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Trisulo Utomo
- Department of Urology, Faculty of Medicine Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Prahara Yuri
- Department of Urology, Faculty of Medicine Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Safendra Siregar
- Department of Urology, Faculty of Medicine Universitas Padjajaran, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muhammad Asykar A Palinrungi
- Division of Urology, Department of Surgery, Faculty of Medicine Universitas Hasannudin, Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | | | | | - Yevri Zulfiqar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Andalas, M. Djamil Hospital, Padang, Indonesia
| | - Yacobda H Sigumonrong
- Department of Urology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia
| | - Hendy Mirza
- Department of Surgery, Persahabatan Hospital, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Mammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci 2019; 28:735-740. [PMID: 30607090 PMCID: PMC6308759 DOI: 10.4314/ejhs.v28i6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hypospadias repair is one of the problematic issues in pediatric surgery. As a result of the multiple complications following the procedure, a variety of techniques have been used and newer methods continue to emerge. There is still controversy regarding the best method of repair. We aimed to determine the outcome of surgery and factors contributing to unfavorable outcomes in children with hypospadias. Materials and Methods This is a retrospective review undertaken from September 2009 to August 2014. The research was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. All children who underwent hypospadias repair and had regular follow-up were included in the study. Results A total of 202 boys aged less than 13 years were assessed. Most surgeries (80.3%) were performed in children older than 18 months. Transverse incised plate urethroplasty (TIP) was frequently performed for distal hypospadias (71.2 %), while transverse ventral preputal flap (TVPF) was the most common procedure done for proximal hypospadias (62.8 %). Overall success rate for first surgery was 55.9 %. There was a high rate of major post-operative complications (44.1%) of which urethrocutaneous fistula (UCF) was the most common (31.2%) followed by meatal stenosis and glans breakdown (7.4 % each). These complications were found to be higher in those who were operated at a later age and those with proximal hypospadias (p=0.03 and p=0.01 respectively). There was also a significant difference among the type of procedures with TIP and TVPF having the least complications (p<0.01). Conclusion From our experience, we found TIP a relatively safe and reliable method of repair for distal hypospadias while TVPF single stage repair was superior in the proximal ones. The high rate of complications in our institution was associated with higher burden of severe hypospadias and older age at surgery.
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Affiliation(s)
| | - Samuel A Negash
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Teamir Negussie
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Hanna Getachew
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Belachew Dejene
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Amezene Tadesse
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
| | - Miliard Derbew
- Unit of pediatric of surgery, Department of surgery, Addis Ababa University, Ethiopia
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Ozkuvanci Ü, Ziylan O, Dönmez MI, Yucel OB, Oktar T, Ander H, Nane I. An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication. Int Braz J Urol 2017; 43:925-931. [PMID: 28727375 PMCID: PMC5678526 DOI: 10.1590/s1677-5538.ibju.2017.0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/09/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. MATERIALS AND METHODS The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. RESULTS The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. CONCLUSION Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.
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Affiliation(s)
- Ünsal Ozkuvanci
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Orhan Ziylan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M. Irfan Dönmez
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Baris Yucel
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tayfun Oktar
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haluk Ander
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismet Nane
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Khan M, Majeed A, Hayat W, Ullah H, Naz S, Shah SA, Tahmeed T, Yousaf K, Tahir M. Hypospadias repair: a single centre experience. PLASTIC SURGERY INTERNATIONAL 2014; 2014:453039. [PMID: 24579043 PMCID: PMC3918360 DOI: 10.1155/2014/453039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/06/2013] [Accepted: 11/04/2013] [Indexed: 11/20/2022]
Abstract
Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital's database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents (P-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair (P value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications.
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Affiliation(s)
- Mansoor Khan
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Abdul Majeed
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Waqas Hayat
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Hidayat Ullah
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Shazia Naz
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Syed Asif Shah
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Tahmeedullah Tahmeed
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Kanwal Yousaf
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
| | - Muhammad Tahir
- Plastic & Reconstructive Surgery, Hayatabad Medical Complex, IV Hayatabad, P.O. Box 25100, Peshawar, Pakistan
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Bhat A, Saxena G, Abrol N. A new algorithm for management of chordee without hypospadias based on mobilization of urethra. J Pediatr Urol 2008; 4:43-50. [PMID: 18631891 DOI: 10.1016/j.jpurol.2007.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/26/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility of chordee correction by mobilization of urethra with corpus spongiosum, and define the guidelines for management of chordee without hypospadias. PATIENTS AND METHODS We reviewed 25 cases of chordee without hypospadias, managed in 1992-2005. Age of patients ranged from 3 to 28years (mean 14.4years). Chordee correction was performed on a case-by-case basis by skin de-gloving, mobilization of divergent corpus spongiosum, mobilization of hypoplastic urethra, mobilization of proximal urethra up to bulbar urethra, dorsal plication and division/resection of hypoplastic urethra with main emphasis on mobilization of urethra, and confirmed by Gittes test. RESULTS Chordee correction was possible by mobilization of urethra after penile degloving in 76% of cases and dorsal plication after urethral mobilization in 8%. Only 16% required division/resection of hypoplastic urethra. None of them had residual chordee in follow-up period of 6months-3years (mean of 26months). After fistula repair and internal urethrotomy in one patient each, a second surgery had 100% success. CONCLUSIONS We propose an algorithm based on mobilization of urethra that defines the etiology and guidelines for the management of chordee without hypospadias.
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Affiliation(s)
- Amilal Bhat
- Department of Urology, S.P. Medical College, Bikaner, Rajasthan 334003, India.
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Hydrodissection Technique to Preserve the Thin Distal Urethra when Correcting Chordee without Hypospadias. J Urol 2002. [DOI: 10.1097/00005392-200211000-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang SSD, Chen SC, Liu SP, Hsieh JT. Hydrodissection technique to preserve the thin distal urethra when correcting chordee without hypospadias. J Urol 2002; 168:2189-91; discussion 2191. [PMID: 12394758 DOI: 10.1016/s0022-5347(05)64352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We introduce a hydrodissection technique to preserve the thin distal urethra when treating chordee without hypospadias. MATERIALS AND METHODS A total of 18 patients with chordee but without hypospadias were surgically treated in 3 years, including 7 (38.9%) with a segment of thin distal urethra. A hydrodissection technique was used to preserve the thin distal urethra in 6 patients with a mean age plus or minus SD of 9.0 +/- 3.6 years. Artificial erection was induced after circumcision and penile skin degloving. Tunica albuginea plication to correct residual chordee was needed in only 1 patient. The thin distal urethra was covered by preputial subcutaneous tissue in 3 cases and by Y to I spongioplasty in 3. RESULTS All 6 thin distal urethras were preserved. The thin distal urethra was a mean of 23.3 +/- 3.9 mm. long and mean followup was 17.8 months. Postoperatively penile cosmesis was excellent in all patients and urinary flow was normal. CONCLUSIONS Using the hydrodissection technique to preserve the thin distal urethra simplifies the operation of correcting chordee without hypospadias by avoiding additional urethroplasty and tunica albuginea plication for residual chordee.
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Affiliation(s)
- Stephen Shei Dei Yang
- Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
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