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Table of Contents   
CASE REPORT
Year : 2011  |  Volume : 16  |  Issue : 4  |  Page : 158-159
 

Hypospadias with dorsal chordee: Case report of a novel approach for correction


Department of Pediatric Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India

Date of Web Publication31-Oct-2011

Correspondence Address:
Jamir D Arlikar
WARD 41, B. J. Building, Grant Medical College and Sir JJ Group of Hospitals, Byculla - 400 008, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.86878

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   Abstract 

We report a novel surgical technique for correction of dorsal chordee with coronal hypospadias. The bulbar elongation and anastomotic meatoplasty procedure gave an excellent cosmetic and functional outcome.


Keywords: Bulbar elongation and anastomotic meatoplasty procedure, dorsal chordee, hypospadias


How to cite this article:
Mane SB, Arlikar JD, Reddy S, Dhende NP. Hypospadias with dorsal chordee: Case report of a novel approach for correction. J Indian Assoc Pediatr Surg 2011;16:158-9

How to cite this URL:
Mane SB, Arlikar JD, Reddy S, Dhende NP. Hypospadias with dorsal chordee: Case report of a novel approach for correction. J Indian Assoc Pediatr Surg [serial online] 2011 [cited 2019 Sep 21];16:158-9. Available from: http://www.jiaps.com/text.asp?2011/16/4/158/86878



   Introduction Top


Dorsal penile curvature is extremely rare; it may or may not be associated with hypospadias. We propose the limited bulbar elongation and anastomotic meatoplasty (BEAM) procedure to simultaneously correct both dorsal chordee and distal hypospadias.


   Case Report Top


A 10-year-old boy presented with a coronal hypospadias and significant dorsal chordee. The glans was conical and the glans groove was deep. There was no fan-shaped marker dorsally over the skin. The dorsal preputial hood was adequate in size and was seen as in usual cases of hypospadias.

The surgical procedure was carried out under regional anesthesia with sedation. After catheterization of the meatus, circum-coronal incision was taken and the penis was degloved up to the base of the penis. A tourniquet was applied and the artificial erection test was performed [Figure 1]. A transverse incision was taken distal to the meatus so as to mobilize the urethra with the spongiosum in a plane close to the corpora cavernosa [Figure 2]. The urethra was mobilized proximally till a point just proximal to maximum curvature. The excess length was excised just proximal to the neo-meatus at the level of the normal corpora spongiosa. Then, meatoplasty and glansplasty was performed. This was adequate enough to correct both dorsal chordee and hypospadias. Complete correction of the chordee was confirmed by repeating the artificial erection test [Figure 3]. An indwelling catheter was left in place and a nonocclusive dressing was applied. The dressing and the catheter were removed on the 10 th day.
Figure 1: Dorsal chordee after degloving, Gittes test

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Figure 2: Urethra was mobilized along with spongiosum in a plane close to the corpora cavernosa

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Figure 3: Straight penis after correction

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At follow-up of 4 years, there was complete disappearance of dorsal chordee and the child was passing urine in a single stream from the tip of the penis.


   Discussion Top


The first case of dorsal penile curvature was reported by Udall in 1980 in a 14-year-old boy. [1] The first reported case of dorsal chordee with hypospadias was published by Redman in 1983. [2] He discussed six cases of dorsal chordee, of which three had distal hypospadias. Scott in 1992 reviewed his experience of surgical correction of 1300 cases between 1976 and1989 and compiled a series of seven cases of distal hypospadias with dorsal chordee. [3]

Udall corrected the deformity by closing three transverse ellipses longitudinally of the tunica albugenia on the dorsal aspect of the penis. [1] Redman corrected the dorsal chordee by removing a pair of ellipses of the tunica albugenia from the ventrum of the penis at the site of maximum curvature, after reflecting the corpora spongiosa and urethra from the corpora cavernosa. [2] Scott corrected the dorsal chordee in all seven cases by using a "reversed Nesbit" procedure. The hypospadias was corrected by the Meatal Advancement and Glansplasty technique in six cases and flip-flap procedure was performed in one case. [3] Both Redman and Scott corrected the hypospadiac urethra as a separate procedure.

The dorsal dissection of the Buck's fascia on corporal bodies invariably damages the neurovascular bundles and makes the penis insensate and, hence, dorsal procedures to correct the chordee are not advocated. [4] The reverse Nesbit's procedure may shorten the penis significantly, particularly when the penis is small. An additional procedure for correction of the hypospadic urethra is required.

Congenital ventral curvature is a normal stage development in the formation of the penis. The extreme rarity of the dorsal chordee has prevented accurate elucidation of its etiology and it is still not well documented. [5],[6],[7],[8]

We propose modified "Beck's procedure" as an ideal procedure for the treatment of this rare entity, dorsal chordee associated with distal hypospadias. [6],[9] This procedure avoids dorsal dissection and the corporal bodies are neither plicated nor are their ellipses excised; thus, alteration to their anatomy is avoided, as seen in the "Reverse Nesbit" procedure. The transposition of the meatus to the tip simultaneously corrects the dorsal chordee and the hypospadias.

 
   References Top

1.Udall DA. Correction of three types of congenital curvature of the penis, including the first reported case of dorsal curvature. J Urol 1980;124:50-2.  Back to cited text no. 1
[PUBMED]    
2.Redman JF. Dorsal curvature of the penis. Urology 1983;21:479-81.  Back to cited text no. 2
[PUBMED]    
3.Spiro SA, Seitzinger JW, Hanna MK. Hypospadias with dorsal chordee. Urology 1992;39:389-92.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Mingin G, Baskin LS. Management of chordee in children and young adults. Urol Clin North Am 2002;29:277-84.  Back to cited text no. 4
[PUBMED]    
5.Kaplan GW, Lamm DL. Embryogenesis of chordee. J Urolnone 1975;114:769-72.  Back to cited text no. 5
    
6.Campbell MF, Harrison JH. Urology. 3 rd ed, vol 2. Philadelphia: W.B. Saunders Co.; 1970. p. 1601-2.  Back to cited text no. 6
    
7.Devine CJ Jr, Horton CE. Bent penis. Semin Urol 1987;5:251-61.  Back to cited text no. 7
[PUBMED]    
8.Koff SA. Mobilization of the urethra in the surgical treatment of hypospadias. J Urolnone 1981;125:394-7.  Back to cited text no. 8
    
9.Beck C. A new operation for balanic hypospadias. N Y Med J 1898;67:147.  Back to cited text no. 9
    


    Figures

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    Tables

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    Abstract
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