Both, Congenital chordee and hypospadias, can have:
- Dorsal hooded foreskin
- Deficient ventral foreskin
- Bifid scrotum
- Penoscrotal transposition
- Penile curvature
A normally positioned urethral meatus distinguishes congenital chordee from hypospadias:
Penile curvature in these conditions is caused by:
- Deficient ventral foreskin.
- Short urethra.
- Abnormal corporal bodies.
Deficient ventral foreskin
The majority of cases of congenital chordee do not have any residual curvature after releasing the foreskin. Thus, most cases can be repaired with just a “fancy” circumcision. I call it “fancy” because it involves transposition of the foreskin from dorsal to ventral, to compensate for the deficient ventral foreskin.
Short urethra or abnormal corporal bodies
When there is still curvature after releasing the foreskin, a dorsal plication suture can be done to correct mild degrees of curvature (less than 30 degrees), in addition to the “fancy” circumcision. If the curvature is greater than 30 degrees, most urologists separate the urethra from the penis.
Separating the urethra from the penis allows access to the ventral side to do 1-3 corporotomies if needed.
Before surgery, a deficient ventral skin, penoscrotal transposition, and a bifid scrotum all suggest a possible short urethra. Intraoperatively, after releasing the skin, pulling the penis up towards the chest with the holding suture will cause the penis to shift to the left and right when the urethra is short.
This patient had 30 degree of ventral curvature (measured using the Photoblend App method) due to a short urethra:
Separating the urethra from the corporas plus a dorsal plication suture corrected the curvature completely:
Once the urethra is separated from the penis, the patient requires a 2 stage STAG repair.
This is the immediate postoperative picture before putting the tie over dressing: