The Hypospadias, Chordee, Orthoplasty and The Prepucial Hood

1.1. Purpose: Making the surgeons aware of the significance of penile chordee, need of optimal straightening of penile shaft (orthoplasty) and appropriate use of well-developed prepucial hood for re-construction of an ideal neo-urethral plate and a near normal neo-urethra by its tubularization and finally re-enforcement of the neo-urethra by prepucial dartos fascial flap to minimize post-operative morbidities. 1.2. Aims and Objectives: Exact assessment of characteristics of chordee by artificial erection of penis, achieving acceptable orthoplasty before commencing upon final neo-urethroplasty and making maximum use of prepucial hood skin in (i) formation of neo-urethral plate and to have an ideal near normal non-hairy and resistance free neo-urethra and or (ii) designing and harvesting various types of skin and or water proofing flaps because of its axial vascularity. 1.3. Material and Methods: Material related to the penile chordee, orthoplasty and appropriate utilization of prepucial hood was collected from the photographic record of hypospadias patients who attended “Hypospadias and VVFs Clinic” between 2004- 2016. Based upon the characteristics of penile shaft and its chordee, various surgical techniques used for acceptable correction of the chordee (orthoplasty) were circum-coronal degloving of penile shaft up to its root, excision of chordee, Dorsal Tunica Albuginea Plication (DTAP), Double Dorsal Tunica Albuginea Plication (DDTAP), Ventral Tunica Albuginea Plication (VTAP), Inner Prepucial Full Thickness Skin Graft (IPFTSG), outer Prepucial Full Thickness Skin Graft (OPFTSG), Dermal Graft (DG), Tunica Vag inalis Graft (TVG) and Tunica Vaginalis Flap (TVF). Accidental breach in Tunica Albuginea (TA) was identified and repaired in water tight fashion. Special care was taken to prevent injury to Dorsal Neuro-Vascular Bundle (DNVB). Hypospadiacs with Bala- clinicsofsurgery.com 2 nitis Xerotica Obliterans (BXO) were excluded from study. 1.4. Observations: Neo-urethroplasty in an uncorrected chordee is deemed to be associated with subsequent anatomical, functional and aesthetic problems, thereby warranting re-do orthoplasty and neo-urethroplasty including total dismantling of the previous surgical repair. The presence of fully developed prepucial hood proved to be a boon to the surgeon in repairing both the fresh as well as re-do cases of neo-urethroplasty and also in harvesting water-proofing flaps to decrease post-operative morbidities. Presence of Undescended Testis (UDT), Inguinal Hernia (IH) and Ano-Rectal Malformation (ARM) are to be corrected on priority.