| Purpose: To compare and analyze the outcome of using tunica vaginalis(TV) for correction of chordee with 2 other traditional approaches : dorsal plication and V-Y flap incision of albuginea. To analyze the clinical efficiency and complications of three techniques in repairing the severe chordee: tunica vaginalis institution and 2nd-stage Snodgrass, dorsal albuginea plication(DAP), V-Y flap procedure and 1st-stage Snodgrass. To further assess TV procedure in repairing severe chordee and provide some references for hypospadias treatment.Methods: Group A:12 boys, aging from 0.8 to 5 years, weighing from 8 to 18 kilograms, with severe hypospadias were received in Dalian Children's Hospital from January 2007 to December 2008. 12 cases underwent operation for the first time. The degree of penile curvature is greater than 35°. The information on age, weight, the degree of ventral chordee, the preoperative and postoperative length of corpora and the defect of urethra, the complications including recurrent curvature, fistula, urethral stricture and diverticulum were recorded in detail. Group B: 23 boys with severe hypospadias were received in Dalian Children's Hospital from January 2007 to December 2008. Group A received TV procedure 1st-stage and 2nd-stage Snodgrass 6 months later. Group B: 23 boys underwent DAP procedure or V-Y flap procedure, 13 of which did DAP and Snodgrass simultaneously, 10 did 1st-stage V-Y flap procedure and 2nd-sondgrass 6 months later. The preoperative and postoperative curved degree, the length of penis and defect of urethra were compared. All patients were followed-up for 3~6 months (average 4.5). The follow-up focuses on curvature, urethral fistula, stricture and diverticulum, the cosmetic appearance of penis and glans, the voiding situation. The satisfying form is not only cosmetic but functional result as well. The recovery standard is: no curved penis, natural appearance of corporal body, glans and meatus, well distributed prepuce, no dysuria, dribbling, spraying.Results:There is no significant difference between two groups in ages, weights, the preoperative degree of chordee, the length of urethral defect or corpora(P> 0.05). The curvature has all been corrected in group A. The urethal defect was from 3.3~4.0cm( median3.64±0.23). The length of corpora was 2.2～5.2cm (median 3.60±0.85). The degree of curvature was from 0°～15°in group B (median 4.67±4.71°). The urethal defect was from 2.4～3.6cm(median 2.95±0.29). The length of corpora was 2.6cm～5.5cm (median 3.21±0.65cm). There is significant difference(P<0.05) between group A and group B in correcting the degree of chordee, the length of urethral defect and corpora. TV procedure has great advatages in penile lengthening,morever, it reduces the tension of urethral plate although it increases the length of urethral defect. Postoperative complications and satisfactions. Group A: 2 fistulas (1 coronary sulcus, 1 corporal body), no stenosis. Group B: 6 cases showed recurrent curvature (simple curvature in 2, associated with fistula and stricture in 4). 6 cases occurred fistula ( 4 coronary sulcus, 2 penile body). 2 cases suffered stricture(1 meatal stenosis, 1 coronary sulcus). There is significangt difference in complications between two groups (P< 0.05). All patients were followed-up for 3~6 months (average 4.5months). The degree of satisfaction: group A 91.7%, group B 73.9%. The two groups were satisfied in the corporal appearance. 11 cases in group A void fluently, no urine spray. 1 was not satisfied with fistula. 17 cases in group were satisfied with the operation. 4 cases were not satisfied with straight erections. 4 cases complained fistula and stricture (2 associated with chordee).Conclusions: TV procedure is safe and effective in the correction of severe chordee, lengthening urethra, decreasing the urethral tension without changing the corporal circumference, especially avoiding many complications, such as recurrent curvature, fistula, stricture and diverticulum. TV with sufficient vascular supply is large enough for tailoring, which is impossible to cause graft necrosis, ischemia and contracture. TV procedure has advantages on correcting chordee completely, preventing recurrent chordee and improving the success rate.
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