R A Bologna1, T A Noah, P F Nasrallah, D R McMahon. 1. Department of Urology, Children's Hospital Medical Center of Akron, Northeastern Ohio Universities College of Medicine 44302, USA.
Abstract
OBJECTIVES: Consensus has not been established as to the best treatment of congenital chordee. Outcomes analysis of treatment options are limited by the prevailing use of ambiguous terminology. We sought to clarify the frequently used term "significant chordee" and to measure the utilization of current treatment strategies. METHODS: A survey covering current practice patterns concerning congenital chordee with hypospadias was sent to 236 members of the American Academy of Pediatrics, Section of Urology. RESULTS: Correction of chordee was the primary concern in hypospadias surgery of 31 % of those responding, but it was not the primary goal of 54% of respondents. Findings indicate that "significant chordee" is clinically defined as curvature greater than 20 degrees, in that 75% of respondents said they would proceed with further intervention. Placement of plicating sutures was the most common therapy chosen for 20 degrees chordee, with 50% of respondents electing this approach. Consensus was reached at 30 degrees chordee, with greater than 99% intervening at this degree of curvature. At 30 degrees curvature, 48% used an incisional Nesbit procedure. As the degree of curvature increased, division or mobilization of the urethral plate became the most common intervention. With 50 degrees chordee, urethral plate manipulation was used 34% of the time. Sixty percent of the respondents believed the urethral plate did not often contribute to chordee. CONCLUSIONS: "Significant chordee" was believed to be a curvature greater than 20 degrees to 30 degrees. With 20 degrees, 30 degrees , and 40 degrees chordee, correction was most often approached dorsally. With 50 degrees chordee, 54% approached the problem ventrally. We hope to encourage the use of more objective measurements and terminology. Objective measurements and long-term follow-up will improve our understanding of the natural history of chordee and improve outcomes analysis.
OBJECTIVES: Consensus has not been established as to the best treatment of congenital chordee. Outcomes analysis of treatment options are limited by the prevailing use of ambiguous terminology. We sought to clarify the frequently used term "significant chordee" and to measure the utilization of current treatment strategies. METHODS: A survey covering current practice patterns concerning congenital chordee with hypospadias was sent to 236 members of the American Academy of Pediatrics, Section of Urology. RESULTS: Correction of chordee was the primary concern in hypospadias surgery of 31 % of those responding, but it was not the primary goal of 54% of respondents. Findings indicate that "significant chordee" is clinically defined as curvature greater than 20 degrees, in that 75% of respondents said they would proceed with further intervention. Placement of plicating sutures was the most common therapy chosen for 20 degrees chordee, with 50% of respondents electing this approach. Consensus was reached at 30 degrees chordee, with greater than 99% intervening at this degree of curvature. At 30 degrees curvature, 48% used an incisional Nesbit procedure. As the degree of curvature increased, division or mobilization of the urethral plate became the most common intervention. With 50 degrees chordee, urethral plate manipulation was used 34% of the time. Sixty percent of the respondents believed the urethral plate did not often contribute to chordee. CONCLUSIONS: "Significant chordee" was believed to be a curvature greater than 20 degrees to 30 degrees. With 20 degrees, 30 degrees , and 40 degrees chordee, correction was most often approached dorsally. With 50 degrees chordee, 54% approached the problem ventrally. We hope to encourage the use of more objective measurements and terminology. Objective measurements and long-term follow-up will improve our understanding of the natural history of chordee and improve outcomes analysis.
Authors: Raoul C M Hennekam; Judith E Allanson; Leslie G Biesecker; John C Carey; John M Opitz; Eric Vilain Journal: Am J Med Genet A Date: 2013-05-06 Impact factor: 2.802
Authors: Bryce A Weber; Luis H P Braga; Premal Patel; Joao L Pippi Salle; Darius J Bägli; Antoine E Khoury; Armando J Lorenzo Journal: Can Urol Assoc J Date: 2014-11 Impact factor: 1.862