The penile disassembly technique in hypospadias repair

Abstract

Objective To report experience and results with penile disassembly in hypospadias repair. Patients and methods From November 1995 to May 1997 penile disassembly was used in 92 patients aged from 9 months to 32 years. The indications for operation were hypospadias with severe penile curvature (especially with curvature in the distal third of the corpora cavernosa), chordee without hypospadias, and small penis with hypospadias. The technique involves separating the penis into its component parts, i.e. the glans cap with neurovascular bundle dorsally, together with the undivided or divided urethra and urethral plate ventrally, and the corpora cavernosa. The manoeuvre allows any curvature to be corrected, especially when in the distal third of the corporal bodies, glans tilt to be rectified, and the penis to be enlarged, particularly elongated, which is a significant gain in small penises with hypospadias. Results The patients were followed for 3–20 months (mean 14); the penis was straightened in all cases, with no recurrence of curvature. In 37 patients (40%) penile disassembly combined with extensive urethral mobilization resolved the hypospadiac meatus with no need to form a neourethra; the penis was larger after surgery. Complications were related to urethroplasty and included four urethral stenoses, two fistulae and three diverticula. There was no injury to the neurovascular bundle and urethra; sensitivity and erection were preserved in all patients. Conclusion The penile disassembly technique is most effective for hypospadias with severe curvature, especially for glans tilt and curvature located distally. Penile augmentation is possible using this technique.

Surgical Treatment of Chordee without Hypospadias

“…In any event, we advise against performing an axial rotation of the corpora cavernosa [8, 9]in this pathology.…”

Penile lengthening

“…The advancement of the penis by ligamentolysis does not produce genuine lengthening because the length of the penile structures remains the same; any increase in penile length is noticeable when¯accid but is minimal when erect. The penile disassembly technique, which we have used successfully in treating congenital penile anomalies [4,5] and transsexual male-to-female surgery [9], enables genuine penile lengthening. The technique allows the complete separation of corpora cavernosa from the other Fig.…”

Recent surgical advances in Peyronie’s Disease

“…48 In this category, patients with a severe penile deviation or with a large plaque in the distal third of the shaft causing curvature of > 60º -70º, severe indentation or shortening, there is still another option, the technique of penile disassembly, described by Perovic in 1998. 49 In this technique the glans and urethra are completely mobilized off of the distal corpora and the pathological tunica albuginea is excised and the glands repositioned, resulting in a functional penis with no remarkable shortening. They reported excellent correction of glans tilt and curvature in the distal third of the corporeal bodies.…”