Amilal Bhat1, Gajendra Saxena, Nitin Abrol. 1. Department of Urology, S.P. Medical College, Bikaner, Rajasthan 334003, India. amilalbhat@rediffmail.com
Abstract
OBJECTIVE: To assess the feasibility of chordee correction by mobilization of urethra with corpus spongiosum, and define the guidelines for management of chordee without hypospadias. PATIENTS AND METHODS: We reviewed 25 cases of chordee without hypospadias, managed in 1992-2005. Age of patients ranged from 3 to 28years (mean 14.4years). Chordee correction was performed on a case-by-case basis by skin de-gloving, mobilization of divergent corpus spongiosum, mobilization of hypoplastic urethra, mobilization of proximal urethra up to bulbar urethra, dorsal plication and division/resection of hypoplastic urethra with main emphasis on mobilization of urethra, and confirmed by Gittes test. RESULTS: Chordee correction was possible by mobilization of urethra after penile degloving in 76% of cases and dorsal plication after urethral mobilization in 8%. Only 16% required division/resection of hypoplastic urethra. None of them had residual chordee in follow-up period of 6months-3years (mean of 26months). After fistula repair and internal urethrotomy in one patient each, a second surgery had 100% success. CONCLUSIONS: We propose an algorithm based on mobilization of urethra that defines the etiology and guidelines for the management of chordee without hypospadias.
OBJECTIVE: To assess the feasibility of chordee correction by mobilization of urethra with corpus spongiosum, and define the guidelines for management of chordee without hypospadias. PATIENTS AND METHODS: We reviewed 25 cases of chordee without hypospadias, managed in 1992-2005. Age of patients ranged from 3 to 28years (mean 14.4years). Chordee correction was performed on a case-by-case basis by skin de-gloving, mobilization of divergent corpus spongiosum, mobilization of hypoplastic urethra, mobilization of proximal urethra up to bulbar urethra, dorsal plication and division/resection of hypoplastic urethra with main emphasis on mobilization of urethra, and confirmed by Gittes test. RESULTS: Chordee correction was possible by mobilization of urethra after penile degloving in 76% of cases and dorsal plication after urethral mobilization in 8%. Only 16% required division/resection of hypoplastic urethra. None of them had residual chordee in follow-up period of 6months-3years (mean of 26months). After fistula repair and internal urethrotomy in one patient each, a second surgery had 100% success. CONCLUSIONS: We propose an algorithm based on mobilization of urethra that defines the etiology and guidelines for the management of chordee without hypospadias.