Extended Urethral Mobilization in Incised Plate Urethroplasty for Severe Hypospadias: A Variation in Technique to Improve Chordee Correction

Abstract

The feasibility of tubularized incised plate urethroplasty in proximal hypospadias with severe chordee was studied after correction of chordee by extended urethral mobilization. Boys with severe hypospadias who underwent tubularized incised plate urethroplasty were included. A total of 34 patients (28 with proximal penile/penoscrotal hypospadias and 6 with scrotal hypospadias) 18 months to 13 years old (mean 5 years) with severe hypospadias underwent tubularized incised plate urethroplasty between January 1999 and March 2006. A Gittes test was performed to assess the chordee after penile degloving and preservation of the urethral plate. Subsequently, the urethral plate with divergent corpus spongiosum and proximal healthy urethra were mobilized up to the bulbar urethra. Glanular chordee was corrected by mobilizing the urethral plate into the glans. The urethral plate was tubularized with or without incision and spongioplasty to complete the urethroplasty. Chordee correction was possible by mobilization of the urethral plate with corpus spongiosum from the meatus to the glans and the proximal urethra up to the bulbar region in 88% of the cases. Mean followup was 23 months (range 6 months to 3 years). Overall complication rate was 12% (fistula in 3 patients, meatal stenosis in 1). Two patients (6%) required dorsal plication, and in 2 (6%) the urethral plate had to be divided to correct the chordee. No patient had residual chordee during followup. The technique of chordee correction by mobilization of the urethral plate and proximal urethra with preservation of the urethral plate is simple and effective, and enlarges the scope of tubularized incised plate urethroplasty in severe hypospadias.