Anatomical features of congenital chordee without hypospadias in children and implication for diagnosis and treatment

Objective To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment. Methods From August 1984 to December 2004, 94 children with chordee without hypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6. 9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type I patients (skin-tethering), those with penis straightened after fibrotic tissue in Buck's fascia released as type II patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type III patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type lV patients (short urethra). Results In type I (n = 31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck's fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type II (n = 45, 47.9%), contracture of Buck's fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type III (n = 6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could not be achieved through releasing these layers. In type IV (n = 12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bands were found to be deep to the urethra. The urethra tethered the corpora cavernosa and formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6 degrees from 42.6 degrees before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory. Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 cases respectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. Conclusion Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes the chief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.