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Ano-Scrotal Distance (ASD) : Is it a marker for the severity of chordee?
Johannes Wirmer1, Michael Sennert1, Ahmed T Hadidi1
1Hypospadias Centre, Department of Pediatric Surgery, Emma and Sana Klinikum Offenbach Hospitals, Germany.
Objective:
To evaluate the relation between ASD and the severity of chordee and hypospadias in a referral center.
Methods:
The distance between the anal verge and proximal scrotal edge (ASD) was measured in hypospadias patients between 6 and 18 months between 2016 and 2020 in the operating room under anaesthesia. Patients older than 36 months and younger than 6 months were excluded. The patients were classified according to meatus into: Grade I (glandular or chordee without hypospadias), II (distal), III (proximal) and IV (perineal). Chordee was assessed by erection test and classified into 2 groups; Group I: no chordee or mild chordee <30 and Group II: with severe chordee >30. Short ASD was defined as ≤ 2.0 cm.
Results:
817 boys were included. The patients were classified according to the hypospadias grades I (180 pt), II (415 pt), III (120 pt) and IV (102 pt). The median ASD for group I was 3.07 cm (range 1.0-5.5), for group II 3.10 cm (range 1.5-5.0), for group III 2.40 cm (range 1.5-54.5) and for group IV 2.10 cm (range 1.0-3.5). The average ASD of the patients in Grade III and IV (2.26 cm) was significantly shorter than the average ASD of the patients in Grade I and II (3.09 cm) (p < 0.05). 184 patients had an ASD ≤2.0 cm. 38% of patients with glanular hypospadias (grade I) with ASD ≤ 2.0 cm had severe chordee.
Conclusion:
This study shows that short ASD is a helpful marker of the severity of chordee and hypospadias. Patients with glanular hypospadias and short ASD have 38% chance of having severe chordee.
