Lengthening the urethral plate with a double flap or a lateral flap technique for repair of primary hypospadias with chordee: 6 year's experience

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Purpose Chordee correction in moderate to severe hypospadias usually implies excision of the urethral plate to achieve adequate penile straightening. There has been an evolution of thought about conservation of the healthy urethral plate in hypospadias surgery. We present the first results with a new 1-stage procedure that achieves satisfactory penile straightening and conservation of the urethral plate. Material and methods From December 1999 to October 2006, 23 pediatric patients with primary moderate or severe hypospadias and chordee underwent this 1-stage urethroplasty. The urethral plate is divided into 2 flaps in an oblique fashion (16 patients) or with an only lateral flap (7 patients). We resect the fibrous ventral tissue after mobilization of the plate and we achieve penile straightening. The ventral side of the neo-urethra is harvested from the prepuce with an onlay island flap (18 patients) or penile skin with the Mathieu “flip-flap” procedure (5 patients). Results Mean follow up was 4.2 years (Range 0.6 to 6.8). No intraoperative complications developed during division of the plate and detethering. 8 post operative complications developed (34.7%): Urethrocutaneos fistulae developed in 6 patients, and 2 meatal retractions that required a GAP procedure. No residual curvature or urethral stricture was noted in our series. All 21 patients had excellent cosmetic results. Conclusions We believe that the lengthening of the urethral plate could be a useful procedure in select cases of primary hypospadias with severe chordee. This technique achieves satisfactory penile straightening and excellent cosmetic results, with a similar complications rate to others procedures for this anomaly.