Repair of the Bulbospongiosus Muscle to Suspend the Penis to the Pubic Bones in Proximal Hypospadias

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BackgroundIn proximal hypospadias, ventral curvature is invariable and most have penoscrotal transposition, and we observed that the base of the penis (BOP) was located on the inferior aspect of the pubic bones in those, in contrast to the location of the BOP at the anterior end in normal penises. We also observed an unfused bulbospongiosus muscle (BSM) at surgery in those. The aim was to assess the impact of repairing the unfused BSM or transection and straightening of the urethral plate at the first operation on the low BOP. MethodAll consecutive proximal hypospadias operations from January 2021 to August 2023 that had a low BOP were retrospectively studied. At the first operation, some had urethral plate transection only, with no BSM repair. Some had BSM repair with or without plate transection. The BOP position was reassessed post-intervention. ResultsThirty-three cases of proximal hypospadias with low BOP were studied. At the first operation, as the key distinguishing step, 18 had BSM repair and 15 urethral plate transections. BOP shifted to the anterior end of the pubic bones in all 18 patients following BSM repair but showed no change in the 15 without BSM repair (p<0.01). Subsequent BSM repair, during the second stage, normalized BOP in those 15. Normalising the BOP corrected penoscrotal transposition because the anterior end of the scrotum was at the anterior end of the pubic bones. ConclusionRepairing BSM is essential for normalising the BOP, which results in a normal penoscrotal relationship and normal anterior penile projection. Level of evidenceIV