Genitourinary and trunk
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Hypospadias results from incomplete closure of the urethral folds during the 12th week of development and may represent abnormal fusion between endodermal and ectodermal processes. It occurs in 1 in every 300 live male births and seems to be increasing; it is characterised by Ventral meatal dystopia, i.e. ventral position of the meatusDorsal hooded foreskinVentral curvature on erection (chordee) This is a fibrous remnant of the corpus spongiosum causing ventral penile curvature that may occur without hypospadias. Dissection of the urethral plate alone will not correct the curvature. In >90% of cases, chordee is due simply to ventral skin shortage; the aetiology is uncertain.Artificial erection test. See below.Deficiency of ventral skinClefting of the glans, and in the most severe cases scrotal bipartition
Hypospadias
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
In one study, a group of 12- to 18-year-old adolescent males who had had their chordee corrected were found to have recurrence of chordee. It is important to know whether straightening of the penis was achieved during the repair of hypospadias and maintained during puberty. Data are lacking about the long-term results of dorsal tunica albuginea plication or other forms of ventral corporal grafting. In a minority of cases recurrence of chordee has been associated with the incorporation of unhealthy urethral plate in the initial urethroplasty, particularly when the chordee is more than 45 degrees. It has been found that the recurrence of chordee is more common when tunica vaginalis or small-intestinal submucosal graft was used for corporal grafting to correct penile curvature. Corporal dermal grafting is successful in 90% of cases to correct penile chordee.
Hypospadias
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
The choice of urethroplasty technique may depend upon the degree of chordee. The penile shaft is degloved after making a subcoronal incision, preserving the urethral plate of 8–10 mm width, except for severe hypospadias such as scrotal and perineal variety in which urethral plate preservation is unlikely from the outset. The penis is evaluated for curvature with an artificial erection test. If the curvature is moderate or severe (greater than 30 degrees), along with short phallic length, correcting chordee by aggressive dorsal corporal plication may not be the best option, since it may lead to shortening of the phallus. In this situation, consideration must be given to division of the urethral plate, excision of ventral fibrous chordee tissues, and use of single or multiple relaxing transverse incisions of the tunica albuginea with or without placement of a corporal patch. The neourethra may then be created later using transposed dorsal preputial skin (staged operation), or immediately with island pedicle flap (transverse island tube urethroplasty), or free graft (oral mucosa graft urethroplasty).
New frontiers on the molecular underpinnings of hypospadias according to severity
Published in Arab Journal of Urology, 2020
Coriness Piñeyro-Ruiz, Horacio Serrano, Marcos R. Pérez-Brayfield, Juan Carlos Jorge
Classification of hypospadias severity follows the anatomical location of the urethral meatus. Clinton K. Smith [12] was the first to classify hypospadias according to the location of the urethral meatus. He classified hypospadias as first degree (opening is situated in the distal one-third of the penis); second degree (proximal two-thirds of the penis to the penoscrotal junction); and third degree (point backward to the perineum). Thereafter, Schaefer and Erbes [5] employed Smith’s degrees as glandular (first degree), penile (second degree), and perineal (third degree). Although these classification systems based on anatomy are useful, clinicians noted that surgical correction of ventral foreskin tethering and/or significant chordee might displace the urethral meatus to a different location, which may lead to misclassification of severity. Therefore, the Sheldon and Duckett [6] classification system, modified after Barcat’s classification, considers the meatus position after chordee has been released. They classified hypospadias as anterior hypospadias, described as glandular (located near the tip of the glans), subcoronal (located just below the coronal sulcus; middle hypospadias (distal penile and midshaft); and posterior hypospadias (proximal penile and penoscrotal meatus), scrotal (located in the scrotum), and perineal (located below the scrotum and perineum). Hypospadias can also be grouped as mild (Type I), moderate (Type II), and severe (Type III) hypospadias, which can be grouped further as mild (Type I) and severe (Type II and III) hypospadias. About 70% of cases are mild, and the remaining 30% are severe [8–10,13,14]. Given the tremendous advances in molecular biology techniques over the last few decades, the present review aimed to highlight the emerging scenarios with regard to key biological factors that have been related to hypospadias according to the severity of the condition.
Non-transecting urethroplasty in patients with bulbar urethral strictures shorter than three centimeters
Published in Scandinavian Journal of Urology, 2023
Muhammet Şahin Yılmaz, Alihan Kokurcan, Fahrettin Şamil Uysal, Görkem Özenç, Fatih Yalçınkaya
Three of 22 (13.6%) patients in the EPA group had complications. While one patient developed erectile dysfunction, one experienced a scrotal hematoma and one developed chordee. The patient with erectile dysfunction was treated with oral tadalafil treatment. Conservative treatment was given for the scrotal hematoma. These patients responded well to these treatments. The chordee was not treated since it was not associated with erectile dysfunction or an inability to have sexual intercourse.
Quantification of the Androgen and Estrogen Receptors in the Penile Tissues of Hypospadias in Comparison with Normal Children
Published in Fetal and Pediatric Pathology, 2023
Sanat Khanna, V. Shankar Raman, Sonia Badwal, K. V. Vinu Balraam
Of the 75 boys in the Group A, majority had DPH (39/75; 52%), 23 cases (30.7%) had MPH (moderate variety) while the remaining 13 cases (17.3%) had PPH or PSH (severe variety). Among these 75 cases, 35 cases (46.7%) had associated chordee with skin chordee accounting for 20, the other 15 were severe.
Related Knowledge Centers
- Penis
- Erection
- Hypospadias
- Peyronie'S Disease
- Birth Defect
- Urethra
- Fibrosis
- Fascia
- Buck'S Fascia
- Dartos