R E Caesar1, A A Caldamone. 1. Department of Urology, Hasbro Children's Hospital, Brown University, Providence, Rhode Island, USA.
Abstract
PURPOSE: Patients with extensive penile chordee may require free graft placement to create a straight phallus. We review our experience with those who underwent primary (no previous surgery) and secondary repair using dermal and tunica vaginalis grafts to correct penile chordee. MATERIALS AND METHODS: Between 1992 and 1998, 28 patients required free graft placement to correct penile chordee. In 8 cases (29%) primary repair was done using tunica vaginalis in 2 and a dermal graft in 6, while in 20 (71%) secondary repair was performed due to recurrent chordee with or without hypospadias. Tunica vaginalis was used in 3 patients and dermal grafts in 17. Grafts were used when straightening did not result from penile shaft degloving, dorsal plication and urethral plate division. Mean followup was 2 years. RESULTS: Residual chordee developed in 1 of 8 patients after primary and in 2 of 20 after secondary repair. Tunica vaginalis grafts had been placed at repair in all patients with residual chordee but there was no recurrent chordee after dermal graft placement. Chordee recurred in 60% of the patients who received a tunica vaginalis graft. CONCLUSIONS: Conventional techniques, such as penile degloving and dorsal plication, may be used to correct penile chordee in most cases, while free grafts are more likely to be required for secondary repair. We believe that dermal grafts result in more successful repair than tunica vaginalis grafts, which seem to be associated with a higher incidence of residual chordee.
PURPOSE:Patients with extensive penile chordee may require free graft placement to create a straight phallus. We review our experience with those who underwent primary (no previous surgery) and secondary repair using dermal and tunica vaginalis grafts to correct penile chordee. MATERIALS AND METHODS: Between 1992 and 1998, 28 patients required free graft placement to correct penile chordee. In 8 cases (29%) primary repair was done using tunica vaginalis in 2 and a dermal graft in 6, while in 20 (71%) secondary repair was performed due to recurrent chordee with or without hypospadias. Tunica vaginalis was used in 3 patients and dermal grafts in 17. Grafts were used when straightening did not result from penile shaft degloving, dorsal plication and urethral plate division. Mean followup was 2 years. RESULTS: Residual chordee developed in 1 of 8 patients after primary and in 2 of 20 after secondary repair. Tunica vaginalis grafts had been placed at repair in all patients with residual chordee but there was no recurrent chordee after dermal graft placement. Chordee recurred in 60% of the patients who received a tunica vaginalis graft. CONCLUSIONS: Conventional techniques, such as penile degloving and dorsal plication, may be used to correct penile chordee in most cases, while free grafts are more likely to be required for secondary repair. We believe that dermal grafts result in more successful repair than tunica vaginalis grafts, which seem to be associated with a higher incidence of residual chordee.