Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias

Abstract

Introduction: Penile degloving is an important step in orthoplasty. Although its role in correcting mild curvature in distal and midshaft hypospadias has been previously reported, its impact on ventral curvature (VC) correction in proximal defects warrants further investigation. Therefore, we sought to document the effect of degloving and proximal urethral dissection on VC correction in children with proximal hypospadias. Methods: We retrospectively reviewed the records of 137 patients who underwent proximal hypospadias repair between 1998 and 2006. VC, defined as mild (<30%), moderate (30%-45%), and severe (>45%), was recorded before penile degloving and after erection test. Percent improvement in VC and need for further treatment (beyond degloving and proximal dissection) based on preoperative degree of curvature were assessed. ANOVA test was used to compare improvement among the 3 groups. Results: Mean age at repair was 14 months (range: 6-24). Penile degloving associated with proximal urethral dissection when necessary was responsible for the improvement in the degree of curvature in 7 of 9 (77%) patients with mild VC, 23 of 44 (52%) with moderate and 35 of 84 (40%) with severe VC. Additionally, degloving alone was sufficient for VC correction in 7 of 9 (77%) mild cases, 14 of 44 (30%) moderate and only 2 of 84 (2%) severe cases. The difference among these 3 groups was statistically significant (p < 0.001). Conclusions: Penile degloving alone can correct VC. The percentage of improvement depends on the preoperative degree of curvature, with severe VC cases showing the least improvement.

Proximal hypospadias: A persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period

“…The severity of VC should be assessed after thorough degloving and excision of all fibrotic ventral bands of the penis. Degloving alone can improve or correct mild and moderated VC [22]. At the present institution, it is preferable to assess VC without tourniquet, accessing the corpora M A N U S C R I P T…”

Management of High-Grade Penile Curvature Associated With Hypospadias in Children

“…Even for proximal hypospadias, degloving the penis alone can correct the VC, and transection of the UP should be avoided before repeating an artificial erection. Weber et al studied 137 patients with proximal hypospadias and reported that degloving the penis alone was sufficient for VC correction in 7 of 9 (77%) mild cases, 14 of 44 (30%) moderate, and only 2 of 84 (2%) severe cases ( 25 ).…”

“…The release of fibrotic tissue and the dartos fascia with scissors should be performed down to the base of the penis. The correction of the curvature is possible with this maneuver and the transfer of dorsal skin to the ventral aspect of the penis ( 25 ).…”

Hypospadias in toddlers: a multivariable study of prognostic factors in distal to mid-shaft hypospadias and review of literature

“…Chordee was defined as a penile shaft curvature and is categorized based on its degree measured by a goniometer: mild (<30), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and severe (>45) curvature. 10 The variables were measured and the operations were performed by a single surgeon to remove potential interobserver variations in the measurements and observations and surgical outcomes. The largest point of UP was recorded as the width.…”