Two-stage repairing of hypospadias cripples with residual severe chordee by reconstructing urethral plates

Abstract

Objective Managing properly hypospadias cripples has been a great challenge for pediatric urologists.We retrospective reviewed our experience of repairing hypospadias cripples with residual severe chordee by reconstructing urethral plates in two stages. Methods From January 2017 to June 2019, retrospective analysis was performed for the clinical data of 3094 surgical cases of hypospadias.Among 1967 initial cases, 1127 were re-operated.And 41/71 cases of chordee penis were corrected by degloving and another 30 children required resecting urethra for straightening penis and repairing in two stages. Results The initial 30 children had an average age of 27.5 months.During reconstruction of urethral plate, the average age was 96.6 months.Previous operations: 1, n=10; 2, n=10; 3, n=3; 4, n=3 cases, 5, n=2; 7, n=2 and previous surgical approaches included Duckett/Duckett & Duplay (n=9), TIP(n=8), staging operation (n=7), free grafting (n=3) and unknown mode (n=3). All 30 cases had severe penile curvature with an average of 52.9 (30-100) degrees.And 17 cases required concurrent folding of dorsal white membrane.The average length of urethral defect was 4.5 cm and the longest defect 8 cm.After urethral transection, urethra plate was reconstructed by local skin and neourethra reconstructed in a second stage.Twenty-one children were reoperated.Urethral fistula (n=3, 14%) was successfully repaired again.Up to now, there was no instance of penile curvature during follow-ups. Conclusions Special attention should be paid to correct penile chordee while managing hypospadias during initial operations.For most cases of hypospadias cripples with severe chordee, urethral transection and neourethral reconstruction may be performed in stages.Prepuce or local penile skin remains the first choice reconstructing urethral plates. Key words: Hypospadias; Penis ventral curvature; Urethroplasty, surgery in stages; Postoperative complications