Date Published: October 9, 2011
Publisher: Hindawi Publishing Corporation
Author(s): Borko Stojanovic, Marta Bizic, Marko Majstorovic, Vladimir Kojovic, Miroslav Djordjevic.
The aim was to retrospectively determine the real incidence of congenital penile curvature in various forms of hypospadias, in order to indicate intraoperative assessment and correction of curvature. We analyzed 842 patients with hypospadias who underwent surgery from 2003 to 2010, classified into two groups. First group was intraoperatively checked for curvature as a routine procedure, while a curvature in the second group was assessed mostly in severe hypospadias. Results are analyzed using Fisher’s and chi-square tests. In total, 238 cases (28.3%) of associated curvature were confirmed. Curvature was significantly more frequent in the first group, regarding hypospadias in general (P < 0.01), as well as distal (P < 0.05) and midshaft forms (P < 0.01). Penile curvature is common figure in hypospadias, including distal types. Intraoperative testing for associated curvature should be considered as a routine procedure in hypospadias repair.
Hypospadias is a congenital defect of the penis resulting in incomplete development of the penile urethra, occurring in approximately 1 in 300 live births. Hypospadias may be accompanied by different genital malformations. The frequency of associated anomalies increases with the severity of hypospadias. Cryptorchidism and inguinal hernia are the most commonly associated anomalies, while curvature of the penis is most common in severe cases of hypospadias. Typically, penile curvature associated with hypospadias is in the ventral direction . It is caused by tethering of the skin, fibrosis, and contracture of the fascial tissue surrounding the urethra, a disproportionately large corpora or a short urethral plate (condition designated as congenital chordee). Associated curvature is diagnosed intraoperatively. The preferred time for surgery is between the ages of 6 and 18 months, before the child develops body image and castration anxiety . Although the patients are not yet adults, when chordee and erectile dysfunction may become apparent, early correction of associated penile curvature will have the positive impact on sexual relationship, confidence, self-esteem, and sexual function in the future .
The study was carried out in the period from 2003 to 2010 at the University Children’s Hospital. Surgical protocols and records were used to register every case of hypospadias and potentially associated curvature treated in this period, including both new and redos. In most cases, reoperations were required due to the occurence of urethral fistula. Hypospadias repair surgeries were performed by two groups of surgeons, and their different assessment of curvature was the criteria for classifying patients into two groups. The patients in group one (I) were intraoperatively tested for curvature as a standard procedure performed by first group of surgeons, using artificial erection or pharmacological erection with prostaglandin E1. As for patients in group two (II), associated curvature was only observed during the surgery or checked for only in proximal, severe hypospadias by the second group of surgeons.
Penile curvature is determined to be common figure in hypospadias, including distal forms. Incidence is statistically analyzed and verified, based on our experience. Intraoperative testing for associated curvature should be considered as a routine procedure in hypospadias repair.