title: Demonstration of postoperative effectiveness in ventral lengthening using a tunica vaginalis flap for severe penile curvature with hypospadias.
abstract: OBJECTIVE
  To evaluate the postoperative effectiveness of ventral lengthening with a tunica vaginalis flap. Correcting penile curvature is an essential step in proximal hypospadias surgery. It is logical to lengthen the ventral radius using a graft; however, penile curvature would recur owing to a graft contracture with inadequate vascularization. Although a tunica vaginalis is considered a suitable material to be used as a flap instead of a graft, clinical application of this technique is uncommon. Information regarding the usefulness and effectiveness of this procedure is required.
  
  
  METHODS
  Between 2003 and 2008, we repaired 146 patients with hypospadias and the urethral plate was transected in 39 patients because of severe curvature. Significant severe curvature persisting even after transection of the plate was corrected with ventral corporeal lengthening procedures using a tunica vaginalis flap in 15 patients and postoperative results were evaluated.
  
  
  RESULTS
  Straight penile erection was identified in all 15 boys at home by their parents. In 7 of the 15 boys, artificial erection was performed at the time of additional surgery; 5 degrees of curvature was found in 2 patients and 0 degree in 5.
  
  
  CONCLUSIONS
  At the second session of surgery, we observed that penile straightening was maintained without recurrence of curvature. Additionally, the area in which the tunica vaginalis flap was placed on the ventrum did not contract. Therefore, lengthening the ventral aspect using a tunica vaginalis flap might be an important alternative for correction of severe penile curvature in hypospadias surgery.
authors: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan. yutaro@med.nagoya-cu.ac.jp
authors: Yutaro
authors: Y
authors: Hayashi
authors: Yoshiyuki
authors: Y
authors: Kojima
authors: Kentaro
authors: K
authors: Mizuno
authors: Akihiro
authors: A
authors: Nakane
authors: Toshiki
authors: T
authors: Kato
authors: Satoshi
authors: S
authors: Kurokawa
authors: Hideyuki
authors: H
authors: Kamisawa
authors: Tetsuji
authors: T
authors: Maruyama
authors: Kenjiro
authors: K
authors: Kohri
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000150:complications* / Q000601:surgery*; D007223:Infant; D008297:Male; D010413:Penis / Q000002:abnormalities* / Q000601:surgery*; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods