Severe Penile Curvature Research Articles

HP-09-004 TachoSil® and the geometric principles of the Egydio technique-a valid and safe combination

To explain and demonstrate the use of a collagen fleece (TachoSil®) as a graft material for severe penile curvatures, which demand an incision and grafting procedure based on the geometric principles of the Egydio technique. To highlight tips and tricks for a correct application of TachoSil® and the geometric principles of the Egydio technique. From March 2016-August 2016 a total of 18 patients underwent an incision and grafting procedure based on the geometric principles of the Egydio technique due to a severe penile curvature caused by Peyronie's disease. Inclusion criteria were: patients with severe Peyronie's disease - patients with good quality erections - patients who were concerned about further penile length loss. 16 patients had a dorsal penile curvature, and 2 patients had a lateral penile curvature. The mean penile curvature was 70 degrees (range, 50-100 degrees). All dorsal penile curvatures were straightened. One of the lateral curvatures had to be revised due to a residual curvature of > 20°. A residual curvature of less than 10 degrees was present in 2 patients. Permanent glans numbness was not present. The intraoperative measured stretched penile length increased by 2.0 cm (range, 1.5-3.0 cm). In foreskin sparing approaches (12 cases) a postoperative lymph edema of the foreskin was present in 50% of cases. All lymph edemas dissolved over the first 6 weeks. All patients resumed sexual intercourse postoperatively. No postoperative erectile dysfunction was recorded.

Bicentric prospective evaluation of corporoplasty with porcine small intestinal submucosa (SIS) in patients with severe Peyronie's disease.

Advanced Peyronie's disease (PD) with severe penile deviation demands grafting procedures following plaque incision or partial plaque excision in order to avoid penile shortening and to improve quality of life of affected patients. Small intestinal submucosa (SIS) is an established xenograft. The objective of the present study was to validate external results in a bicentric prospective manner. Patient selection criteria, surgical technique and standards for pre- and postoperative care were defined. Consecutively, patients with severe penile deviation in stable disease and sufficient erectile function were included between 2007 and 2015. After plaque incision, grafting was performed using SIS in a standardized manner. The postoperative evaluation using a non-validated questionnaire included complications, correction of curvature, pre- and postoperative erectile function, change in penile length and general satisfaction with the procedure. Forty-three patients underwent surgery between 2007 and 2015. The mean degree of preoperative curvature was 73.8° (range 60-90°). No intraoperative or major postoperative complications were reported. After a mean follow-up of 33.0months (range 10-59), complete straightening of the penis was achieved in 74.4%. 88.4% of all patients were able to achieve satisfying sexual intercourse (67.4% unaided, 21.0% with assistance). The IIEF-5 score was improved in 69.8% (mean improvement 4.0 points). Overall 86.0% were satisfied with the surgical treatment. Corporoplasty with SIS in patients with PD and severe penile curvature is a safe approach and shows good long-term results. A thorough patient selection and a standardized pre-, intra- and postoperative procedure are decisive for a satisfying outcome.

02 Shaeer's Corporal Rotation III: Non-Corporotomy Technique for Correction of Severe Penile Curvature

02 Shaeer's Corporal Rotation III: Non-Corporotomy Technique for Correction of Severe Penile Curvature

Biomaterial Grafting Materials in Peyronie’s Disease

Plaque incision/excision and grafting are a specialized procedure reserved for men with Peyronie’s disease, featuring severe penile curvature, near-normal erectile function, and adequate erectile length. The choice of graft material requires careful consideration of the positive and negative attributes. Grafts may be divided into three distinct categories: synthetic, autologous, and extracellular materials. A description of each is presented below with a brief relevant literature review.

Long-term results of combined tunica albuginea plication and penile prosthesis implantation for severe penile curvature and erectile dysfunction.

Penile prosthesis implantation is the recommended treatment in patients with penile curvature and severe erectile dysfunction (ED) not responding to pharmacotherapy. Most patients with mild-to-moderate curvature can expect cylinder insertion to correct both ED and penile curvature. In patients with severe curvature and in those with persistent curvature after corporeal dilation and prosthesis placement, intraoperative penile “modelling” over the inflated prosthesis has been introduced as an effective treatment. We report for the first time the long-term results of a patient treated with combined penile plication and placement of an inflatable penile prosthesis.

758 RESULTS OF CORPOROPLASTY USING PORCINE SMALL INTESTINAL SUBMUCOSA (SIS) IN PATIENTS WITH SEVERE PEYRONIE'S DISEASE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013758 RESULTS OF CORPOROPLASTY USING PORCINE SMALL INTESTINAL SUBMUCOSA (SIS) IN PATIENTS WITH SEVERE PEYRONIE'S DISEASE Khalid Sayedahmed, Mahmoud Salman, Maurizio Aragona, Roman Seibel, Jones Ektutt, Mathias Reichert, and Roberto Olianas Khalid SayedahmedKhalid Sayedahmed Lueneburg, Germany More articles by this author , Mahmoud SalmanMahmoud Salman Lueneburg, Germany More articles by this author , Maurizio AragonaMaurizio Aragona Lueneburg, Germany More articles by this author , Roman SeibelRoman Seibel Lueneburg, Germany More articles by this author , Jones EktuttJones Ektutt Lueneburg, Germany More articles by this author , Mathias ReichertMathias Reichert Lueneburg, Germany More articles by this author , and Roberto OlianasRoberto Olianas Lueneburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.321AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease is relatively common disorder among men, with reported prevalence of 3% to 8%. The occurrence of fibrous scar in the tunica albugenia of the penis is often associated with penile pain and deformity in erect state. Surgery remains the main stay in treatment. We present our results of grafting using SIS for treatment of severe penile curvature caused by this disease. METHODS Retrospective evaluation of 31 patients who underwent corporoplasty using SIS grafting for treatment of severe penile curvature between 2006 and 2012. Variables studied were patient satisfaction, correction of the curvature, erectile capacity and presence of surgical complications. All patients were operated in the same center by the same surgeon. RESULTS Mean follow-up after surgery was 23.8 months (Range 6-50 months). Mean age of patients at time of surgery was 54.3 years (Range 39-66 years). The mean degree of preoperative curvature was 75.6 degree (Range 60-90 degree). The mean plaque length was 2.6 cm (Range 1-3.7 cm). The direction of penile curvature was dorsal in 8 (26%), dorso-lateral in 12 (39%), lateral in 7 (23%) and ventral in 4 (13%) of patients. No intraoperative complications or postoperative infection reported in all cases. One patient (3%) experienced recurrence of the penile curvature and required a new procedure. 3 patients (9.7%) initially reported numbness of the glans penis which was gradually improved and resolved later. 96.4% of patients were satisfied with the penile correction. All cases remained potent. All patients reported significant improvement of their quality of life. CONCLUSIONS Our series suggests that corporoplasty using porcine small intestinal submucosa, in patients with severe penile curvature, is safe and results in satisfactory strait erection during long term follow up. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e311-e312 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khalid Sayedahmed Lueneburg, Germany More articles by this author Mahmoud Salman Lueneburg, Germany More articles by this author Maurizio Aragona Lueneburg, Germany More articles by this author Roman Seibel Lueneburg, Germany More articles by this author Jones Ektutt Lueneburg, Germany More articles by this author Mathias Reichert Lueneburg, Germany More articles by this author Roberto Olianas Lueneburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

How curved is too curved? The severity of penile deformity may predict sexual disability among men with Peyronie’s disease

Peyronie's disease (PD) is caused by progressive fibrotic scarring of the tunica albuginea resulting in curvature or other deformities of the erect penis. The severity of penile curvature or other deformity may contribute to a man's inability to have intercourse (sexual disability), due to difficulty with penetration, partner pain or emotional stress. To determine whether the degree of curvature or type of penile deformity predicts sexual disability among men with PD. This cross-sectional analysis of consecutive men evaluated for PD at a single tertiary referral center used a PD-specific questionnaire to evaluate risk factors for sexual disability in men with PD, who did not have erectile dysfunction (ED). Multivariate logistic regression was used to determine the clinical predictors of sexual disability. Sexual disability as defined by the inability to have penetrative intercourse. A total of 202 men were evaluated and 88 men with ED were excluded. Sexual disability was associated with relationship problems, penile curvature and penile length loss in bivariate, but not multivariate analysis. We found that although many of the demographic, medical and sexual function domains were significant predictors of inability to have sex, the only significant predictor of sexual disability in multivariate analysis was curvature>60° (odds ratio 3.23 95%CI 1.08-9.67). PD can be sexually disabling in many men without ED. Severe penile curvature is a robust independent predictor of the ability to have intercourse. Other penile deformities fail to predict sexual disability. This is important for counseling patients with newly diagnosed PD and those who are considering medical or surgical intervention.

Severe Penile Curvature following Otis Urethrotomy

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

Peyronie 's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. Thirty-three patients with Peyronie 's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections during along-term follow-up.

Re: Ventral Corporal Body Grafting for Correcting Severe Penile Curvature Associated With Single or Two-Stage Hypospadias Repair

Re: Ventral Corporal Body Grafting for Correcting Severe Penile Curvature Associated With Single or Two-Stage Hypospadias Repair

Ventral corporal body grafting for correcting severe penile curvature associated with single or two-stage hypospadias repair

Purpose The literature on small intestinal submucosa for chordee correction in children is scarce. We reviewed our experience with 1 ply SIS for ventral corporal body grafting in cases of severe ventral penile curvature associated with proximal hypospadias in children. Materials and methods From 04-2001 to 12-2007, 58 boys with proximal hypospadias and severe ventral curvature underwent single layered SIS graft to the corporal bodies to correct chordee. In 43 patients the surgery was done in the first stage of a planned 2-stage procedure. Fifteen patients underwent a 1-stage chordee correction with SIS and tubularized transverse preputial flap urethra. Results Mean follow-up was 4.8 years. A straight phallus with good cosmesis was achieved in 57/58 patients. In 51/58 patients an artificial erection was performed in the operating room as part of a second stage procedure or for complications associated with the one stage urethroplasty. One patient needed a second procedure to correct the curvature (chordee was over-corrected and needed a ventral Nesbitt plication). In fifteen patients that underwent a 1-stage genital reconstruction, the neourethral meatus was left in the lower part of the glans in 8 patients and at the coronal sulcus in 7. Conclusions Corporal body grafting with single layer SIS is a viable option for correction of severe chordee associated with corporal body disproportion. SIS is a material with reliable results, easy availability and no donor site associated morbidity. As a result of penile elongation with a graft, simultaneous island flap urethroplasty became difficult in many patients.

Characterization of the urethral plate and the underlying tissue defined by expression of collagen subtypes and microarchitecture in hypospadias

In hypospadia patients, the urethral plate and the underlying tissue were previously thought to be the main cause of penile curvature and, because of this, they used to be excised to correct the curvature. Currently, they are preserved as they are not thought to cause penile curvature anymore. The aim of the present histology study was to elucidate the characteristic structure of the tissue beneath the urethral plate. The experimental group consisted of 27 hypospadiac patients with moderately severe penile curvature, who underwent one-stage urethroplasty after dividing the urethral plate. Excised tissues were observed under light microscopy and transmission electron microscopy (TEM). Furthermore, the presence of collagen subtypes I, III and IV was examined with immunohistochemical staining and western blotting. Light microscopy showed the existence of many massed and intertwined collagen fibers and vessels that resembled those of the cavernous sinus. TEM showed the existence of many collagen fibers, capillary vessels and other structures. Immunohistochemical staining showed collagen subtype I in the interfascicular space and collagen fibers were densely stained. Collagen subtype IV was found in the basement membrane of vessels, but collagen subtype III was not detected. The same results were obtained by western blotting. The tissue beneath the urethral plate was considered to originate from the corpus spongiosum penis. The distribution of collagen subtypes suggests that the presence of the tissue might affect ventral penile curvature. Long-term follow up is required after one-stage hypospadias repair with preservation of the urethral plate and the underlying tissue.

Utilización de un injerto doble de túnica vaginal para la corrección de la curvatura peneana en la enfermedad de La Peyronie. Descripción y análisis de una nueva técnica quirúrgica

Introduction Peyronie's disease is a fibrotic lesión of the túnica albuginea of the penis. Our objetive is to evaluate a new surgical technique where we use a double túnica vaginalis graft in the correction of this pathology. Materials and methods 8 patients were operated with this technique. It consisted in resection of the plaque in 6 cases and incisión of the plaque in 2 and, finally insert the túnica vaginalis graft. All patients had severe penile curvature and did not respond to conservative treatments by a period of 6 months to one year. Results The curvature was corrected in all cases. We observed a recurrence in one patient 14 months after surgery. We observed erectile failure in 4 cases and they were treated with sildenafil. We did not observe inmediate postoperative complications or aneurismatic dilatation of the graft. Conclutions Double túnica vagianlis graft was suitable and cosmetic technique. Postoperatory is brief and well tolerated.

Demonstration of Postoperative Effectiveness in Ventral Lengthening Using a Tunica Vaginalis Flap for Severe Penile Curvature With Hypospadias

To evaluate the postoperative effectiveness of ventral lengthening with a tunica vaginalis flap. Correcting penile curvature is an essential step in proximal hypospadias surgery. It is logical to lengthen the ventral radius using a graft; however, penile curvature would recur owing to a graft contracture with inadequate vascularization. Although a tunica vaginalis is considered a suitable material to be used as a flap instead of a graft, clinical application of this technique is uncommon. Information regarding the usefulness and effectiveness of this procedure is required. Between 2003 and 2008, we repaired 146 patients with hypospadias and the urethral plate was transected in 39 patients because of severe curvature. Significant severe curvature persisting even after transection of the plate was corrected with ventral corporeal lengthening procedures using a tunica vaginalis flap in 15 patients and postoperative results were evaluated. Straight penile erection was identified in all 15 boys at home by their parents. In 7 of the 15 boys, artificial erection was performed at the time of additional surgery; 5 degrees of curvature was found in 2 patients and 0 degree in 5. At the second session of surgery, we observed that penile straightening was maintained without recurrence of curvature. Additionally, the area in which the tunica vaginalis flap was placed on the ventrum did not contract. Therefore, lengthening the ventral aspect using a tunica vaginalis flap might be an important alternative for correction of severe penile curvature in hypospadias surgery.

Corporeal Body Grafting Using Buccal Mucosa for Posterior Hypospadias With Severe Curvature

Severe penile curvature correction by corporeal body grafting has been successfully performed using various grafts and biomaterials. We present our initial experience with buccal mucosa as a free corporeal graft to correct severe penile curvature as part of a multistage approach to posterior hypospadias repair. A total of 12 children with a mean age of 6.2 years (range 4 to 8) with posterior hypospadias and severe ventral chordee (greater than 45 degrees) necessitating ventral grafting underwent correction using buccal mucosa. Preoperative androgen supplement was given when penile and glanular size was significantly small for age. Buccal mucosa was harvested from the inner side of the cheek or the lower lip. The harvested graft was defatted, fashioned and fixed to the ventral corporeal defect. The pre-grafting penile angle, immediate post-grafting angle and penile angle at 6 months were assessed. All children had penoscrotal or perineal hypospadias, 4 had partial androgen insensitivity syndrome and 1 underwent multiple previous failed repairs. Androgen was given preoperatively in 3 children. After chordee release and urethral plate transection the penile angle was between 45 and 80 degrees. Mean graft length and width was 2.5 and 1.6 cm, respectively. All children had a straight penis at the end of the procedure and none required additive dorsal plication. At the last followup at 12 months all children had a straight penis except 2 with mild curvature (less than 10 degrees). No complications were noted with this technique. Preliminary results of the novel use of buccal mucosa as a corporeal graft for severe chordee appear satisfactory. Longer term followup is needed to further document these data.

Long-Term Followup of Dermal Grafts for Repair of Severe Penile Curvature

There is some reluctance to use dermal grafts for augmenting the tunica albuginea to correct severe forms of chordee. The main concern is that by violating the integrity of the tunica albuginea venous leakage could presumably ensue and result in erectile dysfunction. We present our long-term followup of dermal grafts used to correct severe penile curvature associated with hypospadias or as an isolated malformation. A total of 16 patients received a single dermal graft harvested from the nonhair bearing inguinal skin fold. Patient age was 1 to 19 years (average 7). Of the patients 14 had hypospadias, which was scrotal in 12 and perineal in 2, while 2 had congenital penile curvature. In the hypospadias group 13 patients underwent primary repair and 1 had undergone 2 previously failed repairs with persistent severe curvature. Additionally, 5 patients in the hypospadias group had associated penoscrotal transposition. Eight patients in the hypospadias group received testosterone injections preoperatively. Average followup was 10 years (range 6 to 15). At the time of the study all patients were postpubertal and 3 had married. Evaluation of the results was based on patient interview reporting of penile straightness, erectile quality and satisfaction with sexual relations, if present. Two of the 3 patients who married reported satisfactory sexual activity and 1 had fathered children. The other 13 patients reported rigid erections. Two patients had mild residual curvature that would not necessitate any further intervention. Some boys with severe penile curvature, particularly those with hypospadias and a borderline size phallus, need a dermal graft rather than a plication procedure to correct curvature. Our study suggests that using dermal grafts is safe for erectile function.

T05-O-20 Plaque incision surgery with tunica vaginalis patch for penile curvature in La Peyronie's disease: preliminary report

Purpose Peyronie's disease in men with significant penile curvature is often treated with plaque incision/excision and grafting; when erectile dysfunction is associated, a penile prosthesis implantation is mandatory. We present our initial experience of plaque incision surgery with tunica vaginalis patch and concomitant implantation of penile prosthesis in patients with severe curvature due to IPP. Material and methods Nine patients, with severe penile curvature and erectile dysfunction, due to IPP, were considered from January 2006 to October 2007. A circumferential subcoronal and a longitudinal penoscrotal incisions were made. An H-shaped incision was made on the tunica albuginea. The albuginea defect was measured. Through the penoscrotal incision, an adequate tunica vaginalis patch was obtained to restore the defect and it was sutured to the albuginea. Then the penile prosthesis was placed in a standard fashion. Results The mean operative time was 200 + 15 min. In four patients with mild erectile dysfunction a soft penile implant was placed; in five patients with complete erectile dysfunction an inflatable penile prosthesis was positioned. The mean follow up is 13.4 months. We recorded complications in only 1 patient (scrotal hematoma with spontaneous resolution). All patients are able to achieve sexual intercourse. No recurrence of penile curvature have been observed. Only one patient is unsatisfied, due to penile shortening. Conclusions Our experience shows that the plaque incision surgery with tunica vaginalis patch and concomitant implantation of penile prosthesis in patients with severe curvature due to IPP is a safe and efficacious technique, with encouraging satisfaction rate for patients.

Epispadiac Urethral Duplication in an Adult Dorsal Deviated Penis

Urethral duplication is a rare congenital anomaly. Most male patients with complete urethral duplication are diagnosed at childhood with presentation of double urinary streams or urinary dribbling. Incomplete urethral duplication does not result in obvious symptoms except intermittent discharge from the epispadiac urethral opening. Here we report a case of incomplete urethral duplication presenting with severe dorsal penile curvature since adolescence and consequent difficulty with sexual intercourse. We not only corrected the penile curvature but also removed the epispadiac tract followed by a tenuous cord, which suggest that this cord may limit the development of the corpus carvernosum asymmetrically.

Small Intestinal Submucosa for Corporeal Body Grafting in Severe Hypospadias Requiring Division of the Urethral Plate

Severe chordee associated with proximal hypospadias is a challenging problem. Occasionally division of the urethral plate and corporeal body grafting are necessary to achieve a straight phallus. We report our experience with small intestinal submucosa for corporeal body grafting to correct severe chordee associated with proximal hypospadias. We reviewed the charts of all 28 patients who underwent small intestinal submucosa corporeal body grafting to correct severe chordee during stage 1 of planned 2-stage proximal hypospadias repair from January 2001 to June 2006. After mobilization and division of the urethral plate ventral horizontal corporotomies were performed at the site of maximum curvature. Four and 1 ply small intestinal submucosa in 21 and 7 cases, respectively, was then fashioned to size and secured into the defect. Preoperative, operative and postoperative clinic visit records were reviewed to assess outcomes. Preoperatively the meatal position was penoscrotal in 18 patients, scrotal in 5 and perineal in 5. In all patients, who had a mean age of 16 months, the urethral plate was divided and the corporeal bodies were grafted during stage 1 surgery. Vascularized preputial flaps were rotated ventrally for subsequent urethroplasty in 25 patients and buccal mucosa was used for urethroplasty in the remaining 3. A total of 26 patients underwent stage 2 repair with a mean followup of 38 months (range 6 to 61). Overall there were 6 complications, including epidermal retention cysts in 2 cases, partial urethral dehiscence in 2 and urethral diverticulum requiring reduction urethroplasty in 1, while a perimeatal granuloma developed in 1 following stage 1 repair, which required excision. Except the possibility of this latter patient there were no complications related to the small intestinal submucosa graft and a straight phallus without fibrosis was achieved in all 26. Our experience suggests that small intestinal submucosa is a suitable material for corporeal body grafting in 2-stage hypospadias repairs when there is associated severe chordee. In rare instances in which other maneuvers are inadequate to correct chordee small intestinal submucosa grafting is a reasonable option and a low complication rate can be anticipated.

Proximal Hypospadias With Severe Chordee: Single Stage Repair Using Corporeal Tunica Vaginalis Free Graft

We report the results of corporeal tunica vaginalis free graft for single stage correction of severe chordee in children with proximal hypospadias. A total of 18 children with proximal hypospadias and severe chordee underwent tunica vaginalis free graft for correction of chordee and urethroplasty. The graft was anastomosed to the ventral surface of the corpus cavernosum to correct severe penile curvature without dorsal plication of the corpus cavernosum. Single stage urethroplasty was then performed. In cases where the urethral plate was too short for urethral reconstruction a transverse preputial island flap was used for single stage urethroplasty. If the incised urethral plate did not have a well vascularized and supple appearance or the prepuce was not sufficient for phallic coverage, we transected the urethral plate and staged urethroplasty was done. Mean followup was 27.5 months. In 13 patients ventral chordee was corrected using tunica vaginalis free graft without transecting the urethral plate, and urethroplasty was performed in 1 stage. In 3 patients the urethral plate was transected and a transverse preputial island flap was used for single stage urethroplasty. In 2 patients the urethral plate was transected and interposed with dermal graft and tunica vaginalis free graft, followed by staged urethroplasty. There was mild residual chordee in 2 cases. One child had a urethrocutaneous fistula at 2 weeks postoperatively, and 1 presented with obstructive pattern uroflowmetry due to meatal stenosis. In this preliminary report the majority of patients with proximal hypospadias and severe chordee were successfully treated with single stage repair using tunica vaginalis free graft for correction of severe chordee.