Ventral Lengthening Following Transection of the Urethral Plate Alone with Tissue Traction Therapy in Staged Proximal Hypospadias Repair
Cynthia Sze-Ya Ting, MD1, Sze-Wen Ting, MD2, George Kuo, MD1, Pei-Yeh Chang, MD1.
1Chang Gung Memorial Hospital, Taoyuan, Taiwan, 2New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan.
BACKGROUND: Ventral penile curvature is a key factor in determining the surgical approach to proximal hypospadias repair. However, there is limited evidence regarding the efficacy and long-term effects of the procedures used to address curvature. This study aimed to evaluate the effects urethral plate transection on penile curvature in two-stage repair of proximal hypospadias.
METHODS: Primary proximal hypospadias underwent two-stage repair was included. The degree of ventral penile curvature in each patient was measured using a goniometer under artificial erection. Measurements were taken before and immediately after urethral plate transection, and during the second stage of repair. Tissue traction therapy with taping was initiated after stage 1 and maintained until stage 2.
RESULTS: Proximal hypospadias patients who underwent a two-stage repair with urethral plate transection were included (n = 46). No dorsal plication nor corporotomy was done. The median age at the start of treatment was 13 months. The median angle of ventral curvature measured under artificial erection was 70° after devolving, 60° after urethral plate transection, and 0° during the second stage. Of the 46 patients, ventral curvature was fully corrected in 42 (91%).
CONCLUSIONS: Most cases of ventral penile curvature in primary proximal hypospadias can be corrected following urethral plate transection alone with taping in a two-stage repair. Full correction generally occurs over several months after urethral plate transection. Surgeons may reconsider on corporotomy when ventral curvature remains present immediately after urethral plate transection.
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