Chordee without hypospadias: complications and management of the hypoplastic urethra

The surgical correction of chordee without hypospadias may be difficult and result in significant intraoperative and postoperative complications, especially when there is an associated hypoplastic type I urethra. Between 1981 and 1985 we treated 13 patients with this condition. Of the cases 9 had a type I urethra, 3 had type II and 1 had type III, according to the Devine-Horton classification. Postoperatively, glanular tilt persisted in 3 patients, ventral tethering was present in 2 and a fistula developed in 2, for a 54 per cent complication rate. Of the 7 complications 5 occurred in type I cases. Complications may arise from preserving or attempting to preserve a thin hypoplastic urethra. When the paper-thin type I urethra is associated with an abnormal meatus, the entire dysplastic urethra should be reconstructed. If the meatus is normal, clinical judgment must dictate which type I urethras may be preserved and which must be reconstructed.