Chordee without hypospadias: Operative classification and its management

CONTEXT: Developing countries. AIMS: To propose a operative classification of Chordee without hypospadias (CWH) with its management. SETTINGS AND DESIGN: Tertiary referral centre; Retrospective study from January 2000 to January 2011. MATERIALS AND METHODS: Total 26 patients were classified peroperatively into sixtypes (A: Cutaneous chordee→ Degloving skin and dartos (1/26); B: Fibrous chordee→ chordectomy (4/26);C: Corporocavernosalchordee→ Corporoplasty ± Urethral mobilization (4/26); D: Urethral tethering with Hypoplastic urethra→ Urethral mobilization ± urethral reconstruction because of hypoplastic urethra (14/26); E: Congenital short urethra→ excision of urethra from the meatus and urethroplasty (2/26); and F: Complex chordee→ Degloving ± Corporoplasty ± urethroplasty (1/26 patients). The follow-up over 6 months to 9 years were analyzed. STATISTICAL ANALYSIS: SPSS soft ware version 17.0 for Windows. RESULTS: The mean age of surgery was 5.33 ± 0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% (7/26) {including 7.7% (3/26) of associated metal stenosis}. The urethral stricture developed in 3.8% (1/26). CONCLUSIONS: CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results.