title: Proximal hypospadias with severe chordee: single stage repair using corporeal tunica vaginalis free graft.
abstract: OBJECTIVE
  We report the results of corporeal tunica vaginalis free graft for single stage correction of severe chordee in children with proximal hypospadias.
  
  
  METHODS
  A total of 18 children with proximal hypospadias and severe chordee underwent tunica vaginalis free graft for correction of chordee and urethroplasty. The graft was anastomosed to the ventral surface of the corpus cavernosum to correct severe penile curvature without dorsal plication of the corpus cavernosum. Single stage urethroplasty was then performed. In cases where the urethral plate was too short for urethral reconstruction a transverse preputial island flap was used for single stage urethroplasty. If the incised urethral plate did not have a well vascularized and supple appearance or the prepuce was not sufficient for phallic coverage, we transected the urethral plate and staged urethroplasty was done.
  
  
  RESULTS
  Mean followup was 27.5 months. In 13 patients ventral chordee was corrected using tunica vaginalis free graft without transecting the urethral plate, and urethroplasty was performed in 1 stage. In 3 patients the urethral plate was transected and a transverse preputial island flap was used for single stage urethroplasty. In 2 patients the urethral plate was transected and interposed with dermal graft and tunica vaginalis free graft, followed by staged urethroplasty. There was mild residual chordee in 2 cases. One child had a urethrocutaneous fistula at 2 weeks postoperatively, and 1 presented with obstructive pattern uroflowmetry due to meatal stenosis.
  
  
  CONCLUSIONS
  In this preliminary report the majority of patients with proximal hypospadias and severe chordee were successfully treated with single stage repair using tunica vaginalis free graft for correction of severe chordee.
authors.affiliation: Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Hamid
authors.initials: H
authors.lastname: Arshadi
authors.forename: Seyedmehdi
authors.initials: S
authors.lastname: Payabvash
authors.forename: Amirali Hassanzadeh
authors.initials: AH
authors.lastname: Salmasi
authors.forename: Vahid
authors.initials: V
authors.lastname: Najjaran-Tousi
authors.forename: Ali Reza Alam
authors.initials: AR
authors.lastname: Sahebpor
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000601:surgery*; D012704:Serous Membrane / Q000637:transplantation*; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*