title: Correction of penile torsion and chordee by mobilization of urethra with spongiosum in chordee without hypospadias.
abstract: OBJECTIVE
  To investigate the feasibility of correcting coexistent penile torsion and chordee without hypospadias by mobilization of the urethra and spongiosum.
  
  
  METHODS
  A retrospective study of nine patients with simultaneous penile torsion and chordee without hypospadias was undertaken between January 2006 and December 2012. During this period, a total of 364 cases of hypospadias and 38 of chordee without hypospadias were operated on, making a total of 402 patients with hypospadias-related complexes. The same steps were used for correction of both torque and chordee. After a circumcoronal incision, the penis was fully degloved and the spongiosum with urethra was lifted up off the cavernosa. Next, mobilization of the hypoplastic urethra with spongiosum was extended into the glans. If chordee or torque persisted, urethral mobilization was performed proximally up to the bulbar urethra, as required. Spongioplasty and glansplasty were done and a per-urethral stent was kept in for three to five days.
  
  
  RESULTS
  The age of the patients ranged from 5 to 16 years (median 6 years). Penile torsion ranged from 30° to 120°, with a median of 75°. Ventral chordee ranged from 45° to 100°, with a median of 50°. A ratio of 1:9.6 was found for chordee without hypospadias compared to the total hypospadias cases, with an incidence of 9.5%. The ratio of chordee without hypospadias with torsion compared to the total hypospadias cases was 1:29. There was an incidence of chordee without hypospadias with penile torsion of 3.5% in all patients with hypospadias. The ratio of chordee without hypospadias with torsion to only chordee without hypospadias was 1:1.71, with an incidence of 37.0%. Every step contributed to the correction of curvature and torsion. Chordee was corrected in two patients by penile degloving and lifting of the spongiosa off the urethral plate; three patients required additional mobilization of the urethra into the glans. Another two patients needed proximal urethral mobilization and one required a dorsal plication. In five patients, torque was corrected by penile degloving, lifting of the spongiosa and mobilization of the urethra into the glans; four patients required further proximal urethral mobilization. All patients had excellent functional and cosmetic results. No residual chordee or torque was observed in any patient on follow-up at 12-24 months.
  
  
  CONCLUSIONS
  The technique of distally mobilizing a hypoplastic urethra with spongiosum from the corpora into the glans, and proximally up to the bulbar region corrects moderate to severe chordee and torsion with excellent cosmetic results. The incidence of torsion with chordee without hypospadias was 3.5% of all cases of hypospadias.
authors.affiliation: Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: amilalbhat@rediffmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Bhat
authors.affiliation: Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: drkvsabharwal@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Sabharwal
authors.affiliation: Department of Preventive and Social Medicine, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: mahak199027@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Bhat
authors.affiliation: Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: drmanishsingla@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Singla
authors.affiliation: Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: vinaysinghkgmc99@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Urology, S.P. Medical College, Bikaner, Rajasthan, 334003, India. Electronic address: surgeon.ups@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Upadhyay
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000601:surgery*; D010413:Penis / Q000002:abnormalities*; D012189:Retrospective Studies; D013536:Suture Techniques; D014102:Torsion Abnormality / Q000601:surgery*; D014521:Urethra / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: Chordee without hypospadias; Congenital anomaly; Correction; Glanuloplasty; Mobilization of urethra and urethral plate; Penile torsion