Etiology, management and surgical complications of congenital chordee without hypospadias.

PURPOSE

We comprehensively evaluated the etiology, management and surgical complications of chordee without hypospadias.

MATERIALS AND METHODS

We reviewed the records of patients who underwent chordee correction between January 1985 and December 1996. A total of 87 patients with a median age of 14 months were treated for chordee without hypospadias. Mean followup was 10 months. Patients were treated in the standard fashion and a straight phallus was confirmed in all postoperatively. We grouped cases according to the etiology of chordee, including skin tethering, fibrotic dartos and Buck's fasciae, corporeal disproportion and urethral tethering.

RESULTS

Of the 87 patients 28 (32%) were successfully treated with release of the skin and superficial fascia. In 29 cases (33%) extensive resection of the fibrotic dartos and Buck's fasciae was necessary to straighten the phallus, including 2 (7%) in which chordee recurred. Corporeal disproportion was identified in 24 patients (28%), of whom 2 (8%) also had complications (urethrocutaneous fistula and recurrent chordee in 1 each). In 6 cases (7%) urethral tethering was the etiology of chordee, of which 3 (50%) had complications (urethrocutaneous fistula and recurrent chordee in 2 and 1, respectively). Overall 80 of the 87 patients (92%) were successfully treated with 1 operation.

CONCLUSIONS

In our series the etiology of chordee without hypospadias was evenly divided among skin tethering, fibrotic dartos and Buck's fasciae, and corporeal disproportion. A congenitally short urethra was a rare cause of isolated chordee. Surgical correction is highly successful with a low 8% complication rate.