A new algorithm for management of chordee without hypospadias based on mobilization of urethra

Abstract

Objective To assess the feasibility of chordee correction by mobilization of urethra with corpus spongiosum, and define the guidelines for management of chordee without hypospadias. Patients and methods We reviewed 25 cases of chordee without hypospadias, managed in 1992–2005. Age of patients ranged from 3 to 28 years (mean 14.4 years). Chordee correction was performed on a case-by-case basis by skin de-gloving, mobilization of divergent corpus spongiosum, mobilization of hypoplastic urethra, mobilization of proximal urethra up to bulbar urethra, dorsal plication and division/resection of hypoplastic urethra with main emphasis on mobilization of urethra, and confirmed by Gittes test. Results Chordee correction was possible by mobilization of urethra after penile degloving in 76% of cases and dorsal plication after urethral mobilization in 8%. Only 16% required division/resection of hypoplastic urethra. None of them had residual chordee in follow-up period of 6 months–3 years (mean of 26 months). After fistula repair and internal urethrotomy in one patient each, a second surgery had 100% success. Conclusions We propose an algorithm based on mobilization of urethra that defines the etiology and guidelines for the management of chordee without hypospadias.