High grade persistent ventral curvature after multiple hypospadias surgery: how to correct?

ABSTRACT

Introduction:

A challenging situation in proximal hypospadias is the presentation of patients with successful urethroplasty but with persistent or recurrent ventral curvature (VC) after multiple hypospadias repair.

Materials and Methods:

We present a 13 year-old boy with 7 previous surgeries (long TIP, Duplay, meatoplasty) to treat hypospadias presenting with 60 degrees of VC, in spite of a well-accepted coronally neomeatus. We degloved the penis and artificial erection clearly appointed corporal disproportion causing curvature. We disconnected urethra from corpora. After excision of remnant fibrotic tissue, there was a residual curvature so a lenghtening corporoplasty with dermal graft from groin was performed. We have adjusted the urethral meatus position into a proximal penile shaft. We used a buccal mucosa graft placed in an inverted U-shape position planning a second stage urethroplasty (¹). An indwelling silicone Foley tube was left for one week. The patient was discharged the day after surgery.

Results:

The aspect after corporoplasty proved satisfactory curvature correction. Patient had an excellent outcome and is scheduled for a second-stage after 6 months.

Discussion:

Snodgrass and Bush (²) reported that on 73 patients with an average of 2.7 operations for proximal shaft to perineal hypospadias; of which, 83% had VC at re-operation averaging 50°. We do believe that some good results with minimal dorsal plicature may recur in adolescence and therefore when these procedures may be considered, they should be performed by classic Nesbit technique (³). Otherwise, the choice for primary ventral lengthening should be taken.

Conclusion:

Severe curvature associated with hypospadias should undergo a major procedure at early stage to avoid decompensation after dorsal plicature in adolescence. We had a very satisfactory result, the patient awaits the second stage procedure (Figure-1).

Figure 1
End aspect after complete healing of buccal mucosa. Notice that penis is straight and second stage will be performed after 6 months of interval.

REFERENCES

• ¹
  Barroso U Jr, Macedo A Jr. Initial experience with ‘inverted U’ staged buccal mucosa graft (bracka) for hypospadias repair. J Pediatr Urol. 2009; 5:90-2.
• ²
  Snodgrass W, Bush NC. Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol. 2019; 15:344.e1-344.e6.
• ³
  Nesbit RM. Operation for correction of distal penile ventral curvature with or without hypospadias. J Urol. 1967; 97:720-2.

Publication Dates

• Publication in this collection
  11 Mar 2022
• Date of issue
  Mar-Apr 2022

History

• Received
  27 Apr 2021
• Accepted
  12 May 2021
• Published
  20 June 2021