Ritchey Mitchell L, Ribbeck Michaelene
Division of Urology, University of Texas Medical School, Houston, Texas, USA.
J Urol. 2003 Oct;170(4 Pt 2):1574-6; discussion 1576. doi: 10.1097/01.ju.0000083694.44384.39.
Prior reports have suggested that tunica vaginalis free grafts for the treatment of chordee are associated with a high failure rate and residual curvature. We reviewed our experience with tunica vaginalis free grafts for the treatment of severe chordee associated with scrotal and perineal hypospadias.
The records of 25 children with scrotal or perineal hypospadias associated with severe ventral chordee requiring a corporal graft to straighten the phallus treated from 1996 to 2001 were reviewed. Of the cases 5 were reoperative due to prior failed urethroplasty and residual chordee. All patients undergoing primary surgery received testosterone treatment preoperatively. Dermis was used in 3 patients, small intestinal submucosa in 3 and a free graft of tunica vaginalis in the remaining 19. One child had 2 tunica grafts placed at the same setting to correct the chordee.
Patient age ranged from 5 months to 16 years (median 8 months). All patients have been followed for a minimum of 1 year and a maximum of 5 years. All patients completed stage 2 repair of the hypospadias at which artificial erection was performed to detect residual ventral curvature. In only 1 patient with a prior failed hypospadias repair was there evidence of recurrent chordee after tunica vaginalis graft placement. This patient was treated with a dorsal plication at the time of urethroplasty. No other patient had evidence of residual or recurrent chordee.
In our hands, tunica vaginalis grafting of the corpora has produced excellent results. It is a readily available material and easy to harvest in patients who require extensive perineal dissection at the first operation. Long-term followup of these children as they progress through puberty is needed.
