Our Summary

This study investigates a condition called ventral curvature (VC) in boys, which often happens alongside a disorder called proximal hypospadias - a birth defect where the opening of the urethra is on the underside of the penis, not at the tip. This curvature is usually corrected through a surgical technique called dorsal plication (DP). However, the researchers found that VC often returned in boys who had complications from surgery to correct hypospadias.

The researchers looked at their own patients who had undergone a certain type of repair (proximal TIP) and found that recurring VC was quite common. They used a database to identify these patients and document cases of recurring VC. The methods used to straighten the penis included DP using a specific type of suture, as well as other techniques like lifting the urethral plate or moving the urethra. Recurring VC was identified by a specific look of the penis and resistance to lifting the glans (the head of the penis), and was always confirmed via an artificial erection during surgery.

Out of 77 patients, 58 had their VC corrected. However, VC came back in 26% of these cases, and was suspected in another 10% of patients who had recurring complications from their hypospadias surgery.

The researchers concluded that recurring VC after proximal TIP repair occurred in at least 1 in 4 patients, despite the techniques used to straighten the penis while keeping the urethral plate intact. The researchers now only perform proximal TIP when the VC is slight or non-existent. This research suggests that more work needs to be done to improve the outcomes of surgery for boys with proximal hypospadias.

FAQs

  1. What is ventral curvature and how is it related to proximal hypospadias?
  2. What are the common surgical techniques used to correct ventral curvature?
  3. What was the recurrence rate of ventral curvature among patients who had undergone proximal TIP repair surgery?

Doctor’s Tip

A doctor might tell a patient undergoing hypospadias repair to be aware of the potential for recurring ventral curvature (VC) after surgery and to communicate any concerns or changes in the appearance of the penis to their healthcare provider. It is important for patients to follow up with their doctor regularly to monitor for any complications or signs of recurring VC. Additionally, patients may benefit from discussing the specific surgical techniques being used and any potential risks or complications associated with the procedure.

Suitable For

Patients who are typically recommended hypospadias repair are those born with proximal hypospadias, where the opening of the urethra is on the underside of the penis rather than at the tip. Patients with ventral curvature (VC) that often accompanies proximal hypospadias may also be recommended for hypospadias repair. However, it is important to note that recurring VC after surgery to correct hypospadias is a common complication, as seen in the study mentioned above. More research is needed to improve surgical outcomes for these patients.

Timeline

Before hypospadias repair:

  • Patient is diagnosed with proximal hypospadias, a birth defect where the opening of the urethra is on the underside of the penis.
  • Patient may experience ventral curvature (VC) alongside hypospadias.
  • Surgical correction is recommended to address both hypospadias and VC.

After hypospadias repair:

  • Patient undergoes proximal TIP repair surgery to correct hypospadias and VC.
  • VC is corrected in 74% of cases, but returns in 26% of patients.
  • Recurring VC is identified by a specific appearance of the penis and resistance to lifting the glans during examination.
  • Researchers recommend further improvements in surgical techniques to reduce the occurrence of recurring VC after hypospadias repair.

What to Ask Your Doctor

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

  1. What surgical technique will be used to correct my hypospadias?
  2. What are the potential risks and complications associated with the surgery?
  3. How likely is it that ventral curvature (VC) may occur after the surgery?
  4. What steps will be taken to prevent or address recurring VC?
  5. How will I know if I am experiencing recurring VC after the surgery?
  6. What follow-up care will be needed after the surgery?
  7. Are there any long-term effects or considerations I should be aware of?
  8. Are there alternative treatment options available for hypospadias repair?
  9. How experienced is the surgical team in performing this type of surgery?
  10. Can you provide any resources or information for additional support or education about hypospadias repair?

Reference

Authors: Snodgrass W, Bush N. Journal: J Pediatr Urol. 2021 Apr;17(2):222.e1-222.e5. doi: 10.1016/j.jpurol.2020.11.030. Epub 2020 Nov 30. PMID: 33339735