Corporal grafting for severe hypospadias - a single institutional experience with three different techniques
Purpose Correction of severe chordee by corporal body grafting has been successfully performed using a variety of grafts and biomaterials. To date there has been no large single institutional experience comparing the various techniques. We report our outcomes comparing small intestinal submucosa (SIS), tunica vaginalis (TV), and dermal grafts (DG) used for correcting chordee at the time of first stage hypospadias repair. Materials and methods A retrospective chart review was conducted including all patients that underwent two stage hypospadias repair from 1985 to 2006 with corporal body grafting at the first stage. Age at time of surgery, residual chordee at the time of the second stage, and the need for additional placation or chordee correction at the second stage was recorded. Results A total of 71 patients were identified, with a median age at initial corporal grafting of 10 months, and median time between first and second stage of 7.6 months. DG were used in 29, TV in 21, and SIS in 20 patients. One patient had both SIS and TV grafts placed. Complications requiring corporal plication at the time of the second stage occurred with one DG and one SIS graft for minor residual ventral chordee. One patient that had 4-ply SIS developed severe fibrosis required graft excision and regrafting with TV. No single layer SIS grafts had complications. No patient has demonstrated residual chordee after second stage hypospadias repair. Conclusions In a large group of children requiring corporal grafting for severe chordee associated with proximal hypospadias we have demonstrated successful outcomes with SIS, tunica vaginalis or dermal grafts with no significant differences in results.