Dorsal shortening vs. ventral lengthening procedure for correction of congenital ventral curvature in patients with and without severe hypospadias

Abstract

Introduction: Debates remain on the ideal congenital ventral curvature correction among patients with and without severe hypospadias. Herein, we aimed to assess the comparative surgical outcome of dorsal shortening (DS) vs. ventral lengthening (VL) procedures for correcting congenital ventral curvatures. Method: A systematic literature search was performed in September 2021 using the PubMed, EMBASE, Scopus, CENTRAL, ProQuest, and Clinicaltrials.gov databases. Comparative studies were identified and evaluated according to Cochrane Collaboration recommendations. Assessed outcomes included success and complication rates, which were extrapolated for the respective odds ratios (OR) with 95% confidence intervals (CIs). Subgroup analyses were performed according to congenital curvature, with or without severe hypospadias or recurrent curvatures (International Prospective Register of Systematic Reviews (PROSPERO): CRD42021276193). Results: Based on pooled effect estimates from 12 studies with 430 (DS 253, VL 177) cases of ventral curvature repair, VL was able to render a better success rate for curvature correction (OR 4.20, 95% CI 2.11, 8.33) than DS repair, with comparable composite surgical complication rates (OR 0.77, 95% CI 0.27, 2.18). Furthermore, subgroup analysis showed that the success rate remained significantly better for the VL approach among patients with associated severe hypospadias (OR 3.59, 95% CI 1.25, 10.26) and recurrent penile curvatures (OR 5.70, 95% CI 1.69, 19.21), but not among those with congenital curvature without hypospadias or those with mild hypospadias (OR 2.99, 95% CI 0.32, 27.57). Conclusions: In correcting congenital curvature associated with severe hypospadias and recurrent curvatures, VL procedures might render a modestly better success rate; however, careful selection of appropriate patients seems to be the crucial key to the best outcome. The surgical complication rate seems to be comparable between the two approaches.