Can We Preserve the Urethral Plate in Proximal Hypospadias Repair?

PURPOSE: To know the limits of the preservation of the urethral plate in the correction of the curvature associated with proximal hypospadias.

METHODS: From January 2002 to January 2015, we treated 224 patients of proximal hypospadias. In 182 cases, we used of the lateral pictures taken during the successive saline erection tests to measure the correction obtained after each stage.

RESULTS: The analysis of the lateral pictures taken at the successive saline erection tests clearly demonstrated that release of the skin and dartos fascia provides an important correction of the chordee. This correction is complete of all curvature lower than 45 degrees and in 3 fourths of cases for curvatures between 45 and 90 degrees. However, for angles 90 degree and more, the release of the skin and dartos fascia was insufficient in more than 73.7% of cases. And the mobilization of the urethral plate with resection of the underlying fibrous tissue realized gives a very low correction of the chordee (0-20 degrees).

CONCLUSIONS: The essential factor responsible of curvature associated with proximal hypopsadias is the fibrosis tissue present on the ventral side of the penis. However, in the severe forms, a short urethral plate must be transected to obtain a complete correction of the chordee.