A patient with penoscrotal hypospadias has ventral curvature of nearly 60 degrees pre-operatively. After releasing skin and dartos tissue, artificial erection shows the curvature of less than 30 degrees. The next best option is:

A. Transect the uretrhal plate
B. Ventral corporotomy and dermal grafting at the point of greatest bending
C. Proceed with urethroplasty
D. Perform a mid--line dorsal plication

Please select best option and if possible give reasons...


    20 Jan 2021 07:01:37 PM

    D, less than 30 degrees after penile degloving requires penile dorsal plication,

  • aditya gupta
    aditya gupta
    20 Jan 2021 08:34:21 PM

    A. Though campbell says less than 30 degrees dorsal plication can be done but best results are for less than 15 degrees. This being penoscrotal anyways new urethral plate in the form of bmg or other grafts urethroplasty will be needed. Keeping that in mind excision of the fibrotic degenerative urethral plate can be done to see if curvature decreases further. Dorsal plication can be done later which is associated with length loss which i would like to avoid as far as possible. 

  • Virender Sekhon
    Virender Sekhon
    29 Jan 2021 12:14:25 PM

    - Ventral penile curvature of 30 degrees in a pediatric patient needs correction

    - If the urethral plate is good and worth preserving, then lifting it from the underlying corpora and re-assessment of chordee thereafter is suggested. If there is no residual chordee, we can proceed with urethroplasty. If significant chordee is still persisting, option B is suggested.
    - If the urethral plate is not good, its resection along with excision of fibrotic tissue is suggested. 
    - Option D / modifed Baskin's is suggested for minimal residual chordee after all above maneuvres.

    29 Jan 2021 09:54:15 PM

    30 degree is significant. Needs correction. If plate is good and size of phallus is normal I will correct it with dorsal plication

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