Treatment of Hypospadias with Proximal Chordee and Poor Ventral Penile Development
This protocol covers the surgical management of hypospadias in the specific sub-population where the corpus spongiosum divides proximally below the midshaft, accompanied by penile ventral curvature (chordee) and poor development of the ventral penile radius — a combination that requires a carefully structured operative approach.
Clinical Scenario
This sub-population comprises those with a proximal division of the corpus spongiosum with chordee and a poor development of the ventral aspect of the penis (ventral radius). The anatomical combination of proximal urethral position, ventral curvature, and underdeveloped ventral penile tissue defines the scope and complexity of required reconstruction.
Treatment Approach
Surgical management involves a sequenced operative approach addressing chordee correction, urethroplasty, and ventral penile reconstruction — with the specific reconstructive technique selected based on individual anatomy and the condition of the urethral plate.
The complete technique selection criteria, operative sequence, and timing are outlined in the full structured protocol below.
Clinical Goals
- Straight penile erection
- Standing micturition without straining, with a straight and wide urinary stream
- Urethral meatus positioned at the tip of the glans with a slit-shaped opening
References
DOI: 10.4103/0970-1591.40621
- those with a proximal division of the corpus spongiosum with chordee and a poor development of the ventral aspect of the penis (ventral radius).
- The three steps of this reconstruction are to straighten the penis by correcting the chordee, to refashion the missing urethra (urethroplasty) placing the urethral meatus at the tip of the glans and giving it a slit-shaped opening, and to rebuild the ventral aspect of the penis to get a normal looking penis with or without circumcision.
- This reconstruction should allow the child to have micturitions standing up without pushing with a straight and wide stream and to access in adulthood to a satisfactory sexual life with straight erections.
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