Joseph W McQuaid1, Emilie K Johnson2, Elizabeth Andrews1, Ilina Rosoklija2, Marc Cendron3. 1. Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2. Department of Urology, Lurie Children's Hospital, Northwestern University, Chicago, IL. 3. Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: marc.cendron@childrens.harvard.edu.
Abstract
OBJECTIVE: To characterize the spectrum of congenital penile curvature without hypospadias evaluated at our institution, and to assess the efficacy of surgical repair in prepubescent boys. METHODS: The study group included 82 boys with a diagnosis of congenital penile curvature without hypospadias who elected for surgical repair from 2008 to 2010. We retrospectively reviewed clinical and operative characteristics and recorded surgical outcomes during the length of patients' follow-up at our institution. RESULTS: Of the patients electing surgery, 32 of 82 (39%) underwent penile degloving alone for class I (skin) chordee. Ten of 82 patients (12.2%) required further excision of class II (dysgenic fascial) chordee, and 40 of 82 (48.8%) patients required some combination of techniques to correct varying degrees of class III (dysgenic fascial) chordee. A total of 22.2% of patients returning for follow-up with corporal disproportion had persistent penile curvature compared with 14.3% of boys with fascial chordee and 11.5% of boys with skin chordee. Those children treated with tunical plications and incisions alone fared worse than those children treated with some combination of the Nesbit or modified Nesbit procedure. CONCLUSION: Our study shows not only that the proportion of patients with a hyposplastic urethra may be smaller than previously reported but also that corporal disproportion may be more prevalent. Attention should be paid to this later group as plication without the use of Nesbit techniques may not be enough to ensure an appropriate repair.
OBJECTIVE: To characterize the spectrum of congenital penile curvature without hypospadias evaluated at our institution, and to assess the efficacy of surgical repair in prepubescent boys. METHODS: The study group included 82 boys with a diagnosis of congenital penile curvature without hypospadias who elected for surgical repair from 2008 to 2010. We retrospectively reviewed clinical and operative characteristics and recorded surgical outcomes during the length of patients' follow-up at our institution. RESULTS: Of the patients electing surgery, 32 of 82 (39%) underwent penile degloving alone for class I (skin) chordee. Ten of 82 patients (12.2%) required further excision of class II (dysgenic fascial) chordee, and 40 of 82 (48.8%) patients required some combination of techniques to correct varying degrees of class III (dysgenic fascial) chordee. A total of 22.2% of patients returning for follow-up with corporal disproportion had persistent penile curvature compared with 14.3% of boys with fascial chordee and 11.5% of boys with skin chordee. Those children treated with tunical plications and incisions alone fared worse than those children treated with some combination of the Nesbit or modified Nesbit procedure. CONCLUSION: Our study shows not only that the proportion of patients with a hyposplastic urethra may be smaller than previously reported but also that corporal disproportion may be more prevalent. Attention should be paid to this later group as plication without the use of Nesbit techniques may not be enough to ensure an appropriate repair.
Authors: Anthony J Bella; Jay C Lee; Ethan D Grober; Serge Carrier; Francois Benard; Gerald B Brock Journal: Can Urol Assoc J Date: 2018-02-22 Impact factor: 1.862