Recurrent chordee in 59 post pubertal boys
Wael K. Abosena, MBBCh, Moneer K. Hanna, MD,FRCS.
New York Presbyterian-Cornell, New York, NY, USA.
Recurrent chordee in 59 post pubertal boys
Background: As children transition to adolescence penile curvature may recur several years, sometimes, decades following artificial erection proven correction. Herein we review our experience with post pubertal repair of symptomatic recurrent chordee.
Material & methods: We reviewed the charts of 59 symptomatic adolescents aged 14-21 years who presented with recurrent penile curvature causing either sexual dysfunction or significant deformity who had undergone surgical correction between years 2000-2017. Their initial hypospadias repairs were: TIP & dorsal midline plication (28), Theirsch-Duplay (T-D) urethroplasty and Nesbitt dosal repair (9), preputal onlay and Nesbitt repair(6), Two stage Byar repair and ventral dermal graft (3pts). 13/59 patients were repaired elsewhere, and their records were unavailable. Surgical correction included one stage dorsal re-plication and skin de tethering (32pts), One stage urethral mobilization and corporal/dermal grafts (12pts), staged corporal/dermal graft and skin coverage followed by urethroplasty (Grafted TIP) 8-12 months later (15pts).11/59 had had urethral fistulas which were repaired concomitantly.
Results: 55/59 pts. were followed up for 6-48 months (median 30months) by periodic office visits, and 2-4 weeks in 4 patients whom subsequent follow up was by email .53/55 pts. healed well, 2pts developed wound breakdown and scarring resulted in mild recurrent curvature but to a lesser degree than preoperatively. The other 4 pts Corresponded and were pleased with the surgical outcome. 28/59 reported satisfactory sexual function. None of the patients who had corporal/dermal grafts reported any erectile abnormalities.
Conclusions: Recurrent curvature following hypospadias repair if not due to incomplete correction, may be caused by peri-urethral and skin fibrosis and/or disproportionate growth of the relatively hypoplastic ventral corporal wall. Surgical correction of symptomatic patients by dorsal shortening or ventral lengthening procedures depend on the degree of curvature following skin degloving of the penis, nevertheless it must include a preoperative discussion with the patient or parents. Finally,we have been recommending to parents of children born with proximal hypospadias who had received what appear to be good surgical result to follow up after puberty.
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