MP25-14 SURGICAL REALIGNMENT OF PENILE SUSPENSORY LIGAMENT IN PENO-SCROTAL HYPOSPADIAS HAS BETTER COSMETIC AND FUNCTIONAL OUTCOMES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-14 SURGICAL REALIGNMENT OF PENILE SUSPENSORY LIGAMENT IN PENO-SCROTAL HYPOSPADIAS HAS BETTER COSMETIC AND FUNCTIONAL OUTCOMES Ashish Pardeshi, Vijay Raghoji, Navnath Fulari, Pratikshit Mahajan, and Rajesh Rajendran Ashish PardeshiAshish Pardeshi More articles by this author , Vijay RaghojiVijay Raghoji More articles by this author , Navnath FulariNavnath Fulari More articles by this author , Pratikshit MahajanPratikshit Mahajan More articles by this author , and Rajesh RajendranRajesh Rajendran More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Proximal hypospadias is a complex anatomical deformity of the male external genitalia. The Penile Suspensory Ligament (PSL) is an important structure, which defines the peno-scrotal orientation. Abnormal anatomy of PSL leads to an abnormal peno-scrotal orientation and penile shortening. The correction of this abnormal ligament forms the basis of better restoration of peno-scrotal anatomy. We tried to understand the distorted anatomy of the PSL in peno-scrotal Hypospadias and to assess the effect of its surgical realignment in complex proximal hypospadias. METHODS 17 patients of peno-scrotal Hypospadias, between the ages of 5 to 29 years (mean age 8.46 years) were studied from June 2013 to May 2017. 12 patients had no surgical intervention before and 5 were operated previously. All non-operated patients had significant chordee and 2 of the 5 operated patients had residual chordee. All patients had an over-riding bifid scrotum with shortening of the phallus.The surgical steps included: Penile degloving, scrotal exploration, identification of the abnormal attachments of the PSL, release of testes and cord from the abnormally placed PSL, isolation of both PSL and midline realignment and repair of the ligaments with fixation to the penile shaft. RESULTS Penile Length increased by an average of 18.45% to that of the pre-op length in all patients. All patients had undivided round scrotum. All patients had correct orientation of penis and scrotum.Favorable results: • Correction of Peno-scrotal transposition • Increased Penile length • Pendulous scrotum • Correction of Bifid scrotum • Correction of Peno-pubic angle during erection CONCLUSIONS The PSL has 2 parts. The suspensory ligament proper bridges the symphysis pubis and the tunica albuginea of the corpora cavernosa. The fundiform ligament consists of the dartos facial fibers extending from Scarpa’s fascia of the abdomen onto the penile shaft. Xing Liu et al, in 2013 described the correction of fundiform ligament for buried penis. Deeper, elaborate dissection in cases of complex peno-scrotal hypospadias shows abnormal anatomy of the penile suspensory ligaments. This is responsible for abnormal peno-scrotal orientation, buried penis, cleaved and plastered scrotum. Realignment of the PSL is essential for restoration of peno-scrotal anatomy and offers better cosmetic and functional results. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e332 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ashish Pardeshi More articles by this author Vijay Raghoji More articles by this author Navnath Fulari More articles by this author Pratikshit Mahajan More articles by this author Rajesh Rajendran More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...