Small Intestine Submucosa as a Corporal Body Graft in the Repair of Severe Chordee

Abstract

We describe our experience with single and 4-layer small intestine submucosa in the repair of proximal hypospadias and severe chordee. Between 2000 and 2004, 15 boys with proximal hypospadias and/or severe ventral chordee underwent SIS grafting to correct the curvature. Single layer and 4-layer small intestine submucosa were used for corporal grafting. Reassessment was performed by artificial erection at the time of the 2nd-stage reconstruction or at follow-up visit. 1st-stage chordee repair with corporal body incision and graft coverage was performed on 15 patients between June 2000 and March 2004. Single layer SIS was used in 6 cases and 4-layer was used in 9 cases. Twelve of the 15 boys underwent a planned 2nd-stage urethroplasty. Median age at 1st-stage repair was 12 months. A 15-month-old boy underwent single stage chordee correction and penoscrotal hypospadias repair. Two boys without hypospadias underwent chordee correction with SIS. There were no complications related to the use of SIS for chordee repair. Median age of the 12 boys at 2nd-stage hypospadias repair was 24 months. At the time of the 2nd-stage procedures, the graft site did not show more significant scarring than has been our experience in 2-stage procedures performed without SIS. No patients had recurrence of chordee with follow up ranging from 2 to 75 months. Our outcomes suggest that small intestine submucosa is safe and effective for corporal body grafting in the correction of severe chordee, especially in the setting of a multistage hypospadias and chordee repair.