Correction of persistent chordee after TIP repair for proximal hypospadias: Late better than never

Abstract

Abstract Background: Repair of proximal hypospadias remains a challenge with no consensus on the best surgical approach. After penile degloving, a critical decision is whether to preserve or transect the urethral plate that would essentially depend on the degree of associated chordee. Several reports have shown recurrence of chordee after plate-preserving techniques, and the threshold for transecting the urethral plate has been lowered worldwide. In this report, we present our experience in managing cases who presented with persistent/ recurrence of chordee after TIP repair for proximal hypospadias. Methods: Between the period 2015 through 2023, the study included eight patients who presented with ventral penile curvature after previous hypospadias repair in infancy (TIP urethroplasty). Reoperation to correct persistent ventral curvature was performed several years after the primary TIP repair (3-15 years; mean 7.9; median 7.5). The reoperation was a two-stage procedure: first stage comprised transection of the urethra and grafting (lower lip mucosal graft); second stage (6 months later) was a Thiersch-Duplay urethroplasty. Results: Complications included poor take of the graft after the first stage in one case (12.5%), which was regrafted using buccal (cheek) mucosa. Complications after second stage included urethro-cutaneous fistulae in five (62.5%) that were successfully surgically treated at a later stage. Follow up after second stage ranged between 6 months and 7 years (mean 2.4 years; median 1 year). Satisfaction with reoperation to correct penile curvature was noted by parents as well as older children (adolescents) who appreciated better cosmesis by increasing ventral penile length and improved curvature. Conclusion: Preservation of the urethral plate in proximal hypospadias may result in shortened penile length mostly on the ventral aspect. A two-stage reoperation to increase the length of the penile urethra can successfully reverse this complication.