A new approach in hypospadias repair

University of Belgrade, Beograd, Central Serbia, Serbia
World Journal of Urology (Impact Factor: 2.67). 02/1998; 16(3):195-9. DOI: 10.1007/s003450050052
Source: PubMed


The field of hypospadiology remains full of challenges in the search for new and better solutions. In recent years, our concept has involved being very radical in penile reconstructive surgery, using an aggressive approach. The penile disassembly technique, either complete or incomplete, is used successfully in epispadias repair. We began using penile disassembly in hypospadias repair in November 1995. The technique was applied on 112 patients aged from 9 months to 32 years. Indications were: hypospadias with severe penile curvature (especially when the curvature was located in the distal third of the corpora cavernosa), chordee without hypospadias, and small penises with hypospadias. The principle of the technique involves separation of the penis into its component parts: the glans cap with neurovascular bundle (dorsally) together with the nondivided or divided urethra and urethral plate (ventrally) and the corpora cavernosa. This maneuver enables an excellent correction of curvature, especially if it is located in the distal third of the corporal bodies and glans tilt. With this technique, substitution urethroplasty can be avoided or its extent, decreased. It enables penile enlargement, above all its lengthening, which is a significant gain in small penises with hypospadias. The patients were followed for 3-23 months (mean 16 months). Straightening of the penis was achieved in all cases without recurrence of curvature. In 37 patients penile disassembly combined with extensive urethral mobilization solved the problem of hypospadiac meatus without the need to form a neourethra. Complications related to urethroplasty included four urethral stenoses, two fistulas, and three diverticula. There was no injury to the neurovascular bundle and urethra. Sensitivity and erection were preserved in all patients. Penile disassembly is an optimal technique for repair of hypospadias with severe curvature and small hypospadiac penises. Real penile augmentation is possible with this technique.

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    • "The most widely accepted one is modified Devine et al. classification.[1–5] According to which cutaneous chordee corresponds to type III; fibrous chordee, to type II; corporocavernosal chordee, to type IV; and congenital short urethra (CSU), to types I and V.[1–5] On extensive study of the literature, authors believe that all these classifications were confusing and not covering all aspects of the entity. Hence, there is still need for development of easy and understandable classification covering all the aspects of the entity. "
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    ABSTRACT: Developing countries. To propose a operative classification of Chordee without hypospadias (CWH) with its management. Tertiary referral centre; Retrospective study from January 2000 to January 2011. Total 26 patients were classified peroperatively into sixtypes (A: Cutaneous chordee→ Degloving skin and dartos (1/26); B: Fibrous chordee→ chordectomy (4/26);C: Corporocavernosalchordee→ Corporoplasty ± Urethral mobilization (4/26); D: Urethral tethering with Hypoplastic urethra→ Urethral mobilization ± urethral reconstruction because of hypoplastic urethra (14/26); E: Congenital short urethra→ excision of urethra from the meatus and urethroplasty (2/26); and F: Complex chordee→ Degloving ± Corporoplasty ± urethroplasty (1/26 patients). The follow-up over 6 months to 9 years were analyzed. SPSS soft ware version 17.0 for Windows. The mean age of surgery was 5.33 ± 0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% (7/26) {including 7.7% (3/26) of associated metal stenosis}. The urethral stricture developed in 3.8% (1/26). CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results.
    Full-text · Article · Mar 2013 · Urology Annals

  • No preview · Article · Sep 2000 · The Journal of Urology
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    ABSTRACT: We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.
    No preview · Article · Nov 2000 · The Journal of Urology
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