Our Summary

This research paper is about a study that compared two methods of treating a condition called proximal hypospadias, a birth defect in boys where the opening of the urethra (the tube that carries urine out of the body) is not at the tip of the penis. One of the complications of treating this condition is recurrent chordee, which is a persistent curve in the penis.

The two methods compared are dorsal plication (DP) and ventral lengthening (VL). The researchers looked at 17 articles published between 2001 and 2021 that involved 582 patients. They found that the rate of recurrent chordee was significantly lower in patients treated with ventral lengthening compared to those treated with dorsal plication.

Among the different ventral lengthening techniques, the lowest rates of recurrent chordee were seen in procedures involving ventral corporotomies (surgical incisions in the penis), small-intestinal-submucosa (a type of graft from the small intestine), and tunica vaginalis flap (a technique using tissue from the covering of the testes).

The researchers concluded that for treating severe ventral chordee in boys with proximal hypospadias, ventral lengthening procedures are less likely to result in recurrent chordee compared to dorsal plication.

FAQs

  1. What is proximal hypospadias and how is it treated?
  2. What are the two methods compared in this study for treating proximal hypospadias and what were the findings?
  3. What types of ventral lengthening procedures resulted in the lowest rates of recurrent chordee?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hypospadias repair is to discuss with their healthcare provider the option of ventral lengthening procedures, such as ventral corporotomies, small-intestinal-submucosa grafts, or tunica vaginalis flap techniques, as these have been shown to have lower rates of recurrent chordee compared to dorsal plication. It is important for patients to have a thorough discussion with their doctor about the best treatment options for their specific case of hypospadias.

Suitable For

Patients with severe ventral chordee in boys with proximal hypospadias are typically recommended for hypospadias repair. These patients may have a persistent curve in the penis that can cause functional and aesthetic issues. In these cases, surgical intervention is necessary to correct the position of the urethral opening and improve the overall appearance and function of the penis. The study mentioned above suggests that ventral lengthening procedures may be more effective in reducing the risk of recurrent chordee compared to dorsal plication in these patients.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with proximal hypospadias, a condition where the opening of the urethra is not at the tip of the penis
  • Patient may experience symptoms such as difficulty urinating, abnormal curvature of the penis (chordee), and other complications
  • Patient undergoes evaluation by a pediatric urologist to determine the best course of treatment

After hypospadias repair:

  • Patient undergoes either dorsal plication or ventral lengthening surgery to correct the position of the urethral opening
  • Patient may experience pain, swelling, and discomfort in the days following surgery
  • Patient is monitored closely for any signs of complications or recurrent chordee
  • Follow-up appointments are scheduled to assess the success of the surgery and address any concerns or issues that may arise

What to Ask Your Doctor

Some questions a patient should ask their doctor about hypospadias repair include:

  1. What is the success rate of the procedure you are recommending for treating my son’s proximal hypospadias?
  2. What are the potential complications or risks associated with the surgery?
  3. How long is the recovery process expected to be, and what can we expect in terms of post-operative care?
  4. Are there any alternative treatment options available for my son’s condition?
  5. What are the long-term outcomes expected for my son after undergoing this procedure?
  6. Will my son require any additional surgeries or follow-up treatments in the future?
  7. How experienced are you and your team in performing hypospadias repair surgeries, specifically the technique you are recommending?
  8. Can you explain the differences between dorsal plication and ventral lengthening in terms of effectiveness and potential complications?
  9. What is the expected timeline for scheduling and performing the surgery for my son?
  10. Are there any specific pre-operative preparations or precautions we need to take before the surgery?

Reference

Authors: Babu R, Chandrasekharam VVS. Journal: Pediatr Surg Int. 2022 Mar;38(3):389-398. doi: 10.1007/s00383-022-05065-7. Epub 2022 Jan 19. PMID: 35048166