Managing a complex case of hypospadias cripple and chordee

Abstract

Objectives. Hypospadias is a congenital affliction in which the urethral meatus is located on the underside of the penis. These cases are usually treated during childhood by pediatric surgeons, but more complex forms tend to reoccur, and after several failed attempts end up as hypospadias cripple in the care of urologists at an adult age. The aim of this paper is to present the management of a complex case of hypospadias cripple associated with penile curvature (chordee).Materials and Methods. A 24 year old patient presented in our clinic with hypospadias cripple and ventral penile curvature. At the physical examination we found a penoscrotal urethral meatus, heavy scaring of the distal ventral penis and a ventral chordee of approximately 90 degrees in erect state. A two stage "Bracka" repair technique with buccal mucosa graft was chosen. The first stage of the surgery consisted of removing the scarred and defective distal urethral plate and the fibrotic tissue responsible for the penile curvature, preparing the corpora cavernosa for the graft, clefting the glans, harvesting two buccal mucosa grafts from both inner cheeks, and finally quilting the grafts on the defect. The second stage of the repair was performed after a period of about six months, and consisted in the tubularization of the matured graft and glans plasty.Results and Conclusions. No immediate or late complications occurred after any of the two stages of the surgery; no significant ventral chordee was observed and no urethral fistula occurred till the one year follow-up. A two stage "Bracka" repair technique is best suited for treating these patients, correcting ventral chordee in the first session.Costin Gingu et al.

A New 3-Stage Approach for Reoperative Hypospadias

“…The most common option for urethral lengthening, for example, is dorsal incision and tubularization of the urethral plate, but this method can only be performed when there is sufficient good quality urethral plate available contrary to our patients. 8 In these situations, current practice is to do a staged urethroplasty consisting of excision and substitution of the urethral plate with a buccal mucosal graft; this repair is said to be reliable, reproducible, and versatile and ensures good cosmetic and functional results with a vertical slit-like meatus. 8,9 Buccal mucosal grafts in urethroplasty were first described in 1941 by Humby et al, 10 but only recently have surgeons started to FIGURE 1.…”

“…8 In these situations, current practice is to do a staged urethroplasty consisting of excision and substitution of the urethral plate with a buccal mucosal graft; this repair is said to be reliable, reproducible, and versatile and ensures good cosmetic and functional results with a vertical slit-like meatus. 8,9 Buccal mucosal grafts in urethroplasty were first described in 1941 by Humby et al, 10 but only recently have surgeons started to FIGURE 1. Updated decision-making algorithm for hypospadias reoperation.…”