Urethroplasty for chordee with a paper-thin hypoplastic urethra: A long-term study

Area of Science:

• Pediatric Urology
• Reconstructive Surgery

Background:

• Chordee with a paper-thin hypoplastic urethra presents unique surgical challenges in pediatric patients.
• Standardized management protocols are needed to optimize surgical outcomes.

Purpose of the Study:

• To establish a standard surgical procedure for children with chordee and a paper-thin hypoplastic urethra.
• To develop guidelines for managing this congenital penile curvature based on curvature degree and urethral plate quality.

Main Methods:

• A retrospective review of 58 pediatric cases (23–89 months) with chordee and a paper-thin hypoplastic urethra was conducted.
• Surgical techniques including tubularized incised plate, onlay island flap, Duckett urethroplasty, and staged urethroplasty were analyzed.
• Operative details and postoperative complications were evaluated.

Main Results:

• For mild-moderate cases, tubularized incised plate (7.7% complications) showed better outcomes than onlay island flap (20% complications).
• For severe cases, staged urethroplasty (10.3% complications) demonstrated a higher success rate compared to Duckett urethroplasty (27.3% complications).

Conclusions:

• Reconstruction of the entire hypoplastic urethra is recommended for chordee with a paper-thin hypoplastic urethra.
• An algorithm based on curvature and urethral plate quality guides technique selection.
• The tubularized incised plate technique is preferred for mild-moderate cases, while staged urethroplasty is recommended for severe cases.