Correlation of severity of penile torsion with type of hypospadias & ventral penile curvature and their management
AbstractObjective: This study was carried out to evaluate the correlation between the severity of penile torsion on the one hand and the degree of ventral penile curvature and the type of hypospadias on the other. We also assessed the effectiveness of correction of chordee and torsion by penile degloving and mobilization of the urethral plate and the corpus spongiosum.
Patients and methods: This prospective study included 116 patients with hypospadias and penile torsion out of a total of 376 primary hypospadias cases seen between January 2006 and June 2013. The patients’ age ranged from 8 months to 26 years with a mean age of 8.37 and a median age of 6.4 years. Prior to surgery the type of hypospadias as per location of the meatus, the presence or absence of chordee, the size of the dorsal hood and deviation of the median raphe on the dorsal hood were noted. The torque of the penile shaft (torsion) toward either side of the midline and ventral curvature was measured using a sterile small protractor around the penile shaft. The techniques used for the correction of penile torsion and chordee were penile degloving and mobilization of the corpus spongiosum with the urethral plate and the urethra.
Results: The abnormal penile rotation ranged from 15◦ to 110◦ (average 51.98◦). In 70.69% of the patients the torque was on the left side, while it was on the right in 29.31%. 11.2% of the patients had a severe torque, while it was moderate in 37.94% and mild in 50.86% of the cases. The mean torque was 62.38◦ ± 23.03◦ in patients with distal penile (80 cases), 38.04◦ ± 18.50◦ in patients with mid penile (24 cases) and 18.25◦ ± 3.33◦ in patients with proximal penile hypospadias (12 cases) (P value = 0.001). Ventral curvature was seen in 71 cases. Mean ventral curvature was 38◦ ± 18.55◦, 44.28◦ ± 21.11◦ and 73.58◦ ± 32.96◦ in patients with distal penile, mid penile and proximal hypospadias, respectively (P value = 0.001). The procedures of choice for the repair of penile torsion were penile degloving in 11% of the cases, mobilization of the urethral plate and the corpus spongiosum in 28% of the cases, mobilization of the proximal urethra in 40% of the cases and mobilization of the urethral plate into the glans in 21% of the cases. Chordee could be corrected using penile degloving and mobilization of the urethra/urethral plate in all cases.
Conclusions: Penile torque is more common and severe in distal hypospadias, while ventral curvature is seen more often in proximal hypospadias. The degree of torsion is inversely proportional to the severity of ventral curvature. Techniques for the repair of penile torque and ventral curvature include penile degloving and mobilization of the urethral plate with the corpus spongiosum and the urethra.