Proximal Hypospadias: Effect of Urethral Plate Mobilization on Release of Chordee

ObjectiveTo accurately measure the correction obtained by the release of the skin and dartos fascia and that obtained by mobilization of the urethral plate and resection of the underlying fibrous tissue (according to Koyanagi and Mollard), in the release of chordee.MethodsFrom February 1996 to February 2011, 234 patients underwent surgery for proximal hypospadias by 1 surgeon. Lateral photographs were taken during successive saline erection tests for 205 patients. The first test was performed at the beginning of the operation, the second test after the release of the skin and dartos fascia, the third test after possible mobilization of the urethral plate and resection of the underlying fibrous tissue, and the last test at the end of surgery.ResultsPreservation of the urethral plate was possible in 191 patients (93%). Analysis of the lateral photographs showed that stripping of the penis resulted in complete correction of all chordee <45°. For curvature >90°, stripping of the penis was insufficient in 88% of the cases. However, mobilization of the urethral plate with resection of the underlying fibrous tissue resulted in very low correction (10°-20°), although the blood supply to this plate was preserved.ConclusionThe results of the present study have shown that correction of the curvature that accompanies proximal hypospadias is obtained mainly by release of the skin and dartos fascia.