Journal of pediatric urology · 2026
Efficacy of three corporotomies to correct ventral penile curvature. Experience in 400 patients with severe hypospadias.
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Snodgrass Warren, Bush Nicol
Аннотация
PURPOSE: We determined the efficacy of 3 corporotomies to straighten ventral curvature (VC) measuring 30-135° during the first stage of a 3-stage STAC repair in patients with proximal hypospadias, as confirmed by artificial erection (AE) at STAC 2 and STAC 3.
METHODS: Consecutive males with proximal hypospadias and VC 30° or more underwent primary or reoperative STAC repair. Straightening was done by 3 ventral corporotomies during STAC 1, with AE repeated during STAC 2 and 3, and any reoperations after STAC repair for complications. Residual VC at STAC 2 was straightened by 1 Heineke-Mikulicz dorsal plication. The primary outcome was any ventral curvature. Secondary outcomes included bleeding complications requiring intraoperative or postoperative intervention, and reported change in erection quality in Tanner 4,5 patients.
RESULTS: There were 237 primary and 163 reoperative STAC repairs done between 2019 and 2024. VC averaged 74° (median 75°) in primary cases, with 85 % having more than 30-45° and 1 in 4 more than 90°. VC in reoperations was less (p < 0.00001), averaging 54° (median 50°). All patients had at least 2 AE after corporotomies, with the final an average of 17 (11.5-58) months later. 81 % had no VC at STAC 2. Residual VC in the remainder was always 30° or less, was more common in those with >90° initially (p < 0.00001), and was successfully corrected with a single Heineke-Mikulicz dorsal plication in most. Therefore, 99 % of patients were proven by AE to have successful straightening. There were no bleeding complications requiring intervention. One adult reported 15 % decrease in erection fullness.
CONCLUSIONS: 3 corporotomies alone were successful in 81 %, which increased to 99 % with a subsequent dorsal plication in those with residual VC. The fact that residual curvature occurs after all straightening methods, including 3 corporotomies, emphasizes need for AE to be repeated at the next operation in staged repairs and during reoperations.
METHODS: Consecutive males with proximal hypospadias and VC 30° or more underwent primary or reoperative STAC repair. Straightening was done by 3 ventral corporotomies during STAC 1, with AE repeated during STAC 2 and 3, and any reoperations after STAC repair for complications. Residual VC at STAC 2 was straightened by 1 Heineke-Mikulicz dorsal plication. The primary outcome was any ventral curvature. Secondary outcomes included bleeding complications requiring intraoperative or postoperative intervention, and reported change in erection quality in Tanner 4,5 patients.
RESULTS: There were 237 primary and 163 reoperative STAC repairs done between 2019 and 2024. VC averaged 74° (median 75°) in primary cases, with 85 % having more than 30-45° and 1 in 4 more than 90°. VC in reoperations was less (p < 0.00001), averaging 54° (median 50°). All patients had at least 2 AE after corporotomies, with the final an average of 17 (11.5-58) months later. 81 % had no VC at STAC 2. Residual VC in the remainder was always 30° or less, was more common in those with >90° initially (p < 0.00001), and was successfully corrected with a single Heineke-Mikulicz dorsal plication in most. Therefore, 99 % of patients were proven by AE to have successful straightening. There were no bleeding complications requiring intervention. One adult reported 15 % decrease in erection fullness.
CONCLUSIONS: 3 corporotomies alone were successful in 81 %, which increased to 99 % with a subsequent dorsal plication in those with residual VC. The fact that residual curvature occurs after all straightening methods, including 3 corporotomies, emphasizes need for AE to be repeated at the next operation in staged repairs and during reoperations.