Ano-Scrotal Distance (ASD) : Is it a marker for the severity of chordee?

Abstract

To evaluate the relation between ASD and the severity of chordee and hypospadias in a referral center. The distance between the anal verge and proximal scrotal edge (ASD) was measured in hypospadias patients between 6 and 18 months between 2016 and 2020 in the operating room under anaesthesia. Patients older than 36 months and younger than 6 months were excluded. The patients were classified according to meatus into: Grade I (glandular or chordee without hypospadias), II (distal), III (proximal) and IV (perineal). Chordee was assessed by erection test and classified into 2 groups; Group I: no chordee or mild chordee <30 and Group II: with severe chordee >30. Short ASD was defined as ≤ 2.0cm. 817 boys were included. The patients were classified according to the hypospadias grades I (180pt), II (415pt), III (120pt) and IV (102pt). The median ASD for group I was 3.07cm (range 1.0-5.5), for group II 3.10cm (range 1.5-5.0), for group III 2.40cm (range 1.5-54.5) and for group IV 2.10cm (range 1.0-3.5). The average ASD of the patients in Grade III and IV (2.26cm) was significantly shorter than the average ASD of the patients in Grade I and II (3.09cm) (p<0.05). 184 patients had an ASD ≤2.0cm. 38% of patients with glanular hypospadias (grade I) with ASD≤2.0cm had severe chordee. This study shows that short ASD is a helpful marker of the severity of chordee and hypospadias. Patients with glanular hypospadias and short ASD have 38% chance of having severe chordee.