INTRODUCTION AND OBJECTIVES: The literature on small intestinal submucosa (SIS) for chordee correction in children is scarce. We reviewed our experience with 1 ply SIS for ventral corporal body grafting in cases of severe ventral penile curvature associated with proximal hypospadias in children.

METHODS: Between April 2001 to December 2007, 58 boys with proximal hypospadias and severe congenital ventral curvature underwent single layered SIS graft in the corporal bodies to straighten the phallus. Mean patient age at surgery was 25 months (range 6 to 180 months). In 43 patients the surgery was done in the first stage of a planned 2-staged procedure. Fifteen patients underwent a 1-stage chordee correction with SIS and transverse preputial island flap urethroplasty. Preoperative, operative and postoperative records were reviewed to assess outcomes. Straight erections were documented by parent reports, patient self-assessment or an artificial erection test intraoperatively during the stage 2 procedure or for complications related to one-stage hypospadias repair.

RESULTS: Mean follow-up was 42 months. Patients have at least 23 months of follow-up. In 51/58 patients, an artificial erection was performed in OR. Overall, a straight phallus without fibrosis was achieved in 57/58 (98.3%) patients. Forty three patients underwent a planned 2-stage repair with subsequent urethroplasty 6 to 12 months after chordee correction. In 42/43 (97.7%) of these patients, the cosmetic and functional results were excellent, with straight erections and good penile length. One patient needed a second procedure to correct the curvature. In this patient chordee was over-corrected and needed a ventral Nesbitt plication. Fifteen patients underwent a 1-stage chordee correction with SIS and transverse preputial island flap urethroplasty. The neourethral meatus was left in the lower part of the glans in 8 patients and at the coronal sulcus in 7. A straight phallus without fibrosis was achieved in all patients. In 7 patients, without a post-operative artificial erection in the OR, follow-up were documented by patients and/or parents and reported good results with straight, non painful erections.

CONCLUSIONS: Corporal body grafting with single layer SIS is a viable option for correction of severe chordee associated with corporal body disproportion. SIS is a material with reliable results, easy availability and no donor site associated morbidity. In our opinion the 2 stage procedure is a reliable and reproducible technique with better cosmetic outcomes in this difficult cohort of hypospadias patients.

Source of Funding: none