PD48-04: Recurrent Curvature After Corporoplasty with Tunica Vaginalis Flap: An Analysis of Boys Who Underwent Ventral Penile Lengthening for Proximal Hypospadias

Kathy Huen*, Amanda Macaraeg, Carol Davis-Dao, Sarah Holzman, Timothy Boswell, Zayn Suhale, Kai-Wen Chuang, Heidi Stephany, Elias Wehbi, Antoine Khoury, Orange, CA

Introduction: Optimal means to correct ventral curvature (VC) is debated. Our preferred technique for curvature >45° is corporoplasty using tunica vaginalis flap (TVF). We describe our complications with TVF for ventral lengthening.

Methods: 44 boys who underwent ventral lengthening with a corporoplasty with TVF were identified in a prospective database for proximal hypospadias repair by a single surgeon from 2008-2021 (IRB# 190105).  Corporotomy was performed by incising the tunica albuginea of the corpora cavernosa transversely at the point of maximum curvature. Harvested TVF with preserved vascularity was on laid to the corporal defect.

Results: Median age at surgery was 1.0 years (interquartile range (IQR) 0.72-1.82). Median follow-up time was 4.4 years (IQR 2.1-7.3). 10 patients (22%) were > 10 years of age at last follow up (median 13.3, range 10-20). 22 boys (50%) received preoperative testosterone. The most common location of the meatus after degloving was penoscrotal (41%).  Median VC after degloving was 90° (IQR 80-100). The urethral plate was transected in 98% of boys, improving median VC to 60° (IQR 40-60).  After corporotomy, the median longitudinal distracted distance was 15 mm (IQR 12-17).  Urethral reconstruction was most commonly achieved with the transverse island preputial flap technique or its modifications (93%). Erections were reported in 41 boys (93%), and none had corporal diverticula. 3 boys had recurrent VC (RVC; 3/44, 7%). Median RVC was 30° (IQR 30-45). 1 had RVC at the penoscrotal junction (not at site of prior corporoplasty) identified 11 years post op at age 15 years, and underwent dorsal plication. The other 2 patients were diagnosed < 1 year post op. Both received testosterone due to small glans size, and had double-face tubularized transverse island preputial flap as urethral and ventral skin coverage.  On endocrine workup for disorders of sexual differentiation, one had a gene mutation that codes for the SF-1 protein, which is central to the regulation of steroid synthesizing genes.  Another had genetic consultation for the constellation of hemivertebrae, facial hemangioma, short stature and hypospadias, with no conclusive diagnosis. Both had scarring of the preputial flap and of the corporoplasty. Scar excision and superficial transverse incisions on the tunica albuginea corrected RVC.

Conclusions: The intermediate-term outcome of ventral penile lengthening using TVF for corporoplasty is favorable with 7% of boys with RVC and none with corporal diverticula.

Source of Funding: None