Acellular dermal matrix graft for ventral corporal lengthening orthoplasty in 2-stage proximal hypospadias repair

BACKGROUND: Correcting ventral curvature (VC) by lengthening the ventral corpora using a graft has been verified feasible, but still has been associated with the recurrence. The use of acellular dermal matrix (ADM) in the setting of tissue reconstruction has captured the attention of many surgeons. There are few reports on the use of ADM exclusively as correction of VC. Thus, we evaluate the safety and effectiveness of repairing the defect with ADM for straightening the VC in proximal hypospadias repair. METHODS: We retrospectively analyzed the records of patients with proximal hypospadias who underwent ventral corporal lengthening with graft in staged repair from January 2013 to December 2019. Those with curvature greater than 30° after urethral plate transection were enrolled. ADM was used for repairing the defect left by transversely transection of tunica albuginea. Patient outcomes were compared with the non-matched control group who underwent the same procedure with tunica vaginalis (TV) repair. Patient demographics, operative techniques, complications, reoperations were summarized and compared between 2 groups. RESULTS: Forty-three patients underwent ventral lengthening with ADM repair after transverse urethral plate transection and 35 patients with TV patching respectively. At a mean follow-up of 10 months in those with the first-stage ventral lengthening, 5 of 43 (11.6%) in ADM group was detected with recurrent VC, while 2 of 35 (5.7%) in TV group were observed with recurrent curvature contemporarily (P=0.363). At a mean follow-up of 46.8 and 45.3 months, persistent curvature in ADM group was not significantly different comparing to TV group (1/43, 2.3% vs. 1/35, 2.9%; P=0.883). CONCLUSIONS: Ventral corporal lengthening using ADM graft may facilitate correction of VC without increasing the risk of urethroplasty complications. It offers a promising material that can be safe, effective and simple to use and provides psychological and aesthetic benefits. Additional series assessment and further randomized controlled trials will elucidate the clinical impact of using ADM with ventral lengthening.