PD48-05: Short- and Long-term Outcomes of Small Intestinal Submucosa for Corporeal Body Grafting in Patients with Proximal Hypospadias and Severe Chordee

Maria Camila Suarez*, Christian Guevara, Daniel Nassau, Andrew Labbie, Andrew Ransford, Alireza Alam, Miguel Castellan, Rafael Gosalbez, Miami, FL

Introduction: Severe ventral chordee commonly occurs in proximal hypospadias, and corporal body grafting is the preferred surgical technique to correct severe curvature since it preserves penile length. Small intestinal submucosa (SIS) can be used for corporal grafting; however, there is a paucity of data evaluating short- and long-term outcomes. We aimed to determine the short-term recurrence of chordee and graft related complications, and the long-term sexual and erectile function in patients with proximal hypospadias and severe chordee treated with 1-ply SIS to correct penile curvature.

Methods: Retrospective chart review of patients with proximal hypospadias who underwent correction of severe chordee with 1-ply SIS from 1998-2019. Exclusion criteria included follow-up <6 months. Post-pubertal patients (age = 144 months) were asked to answer the following validated questionnaires: the Modified Erection Hardness Score (mEHS) and the Pediatric Penile Perception Score (PPPS). A physical exam was performed, and results were compared to the Hypospadias Objective Scoring Evaluation (HOSE).

Results: A total of 153 patients were evaluated for short-term outcomes. The mean age at surgery was 26 months with a mean follow-up of 55 [IQR: 18-96] months. From the patients who underwent a second stage (91.5%), an artificial erection at time of surgery identified a residual chordee in 10 cases which was corrected with plications. The only graft-related complication was 1 case of severe SIS contracture that required replacement. None of the patients exhibited residual chordee (=10 degrees) during their last follow-up. Long-term outcomes were evaluated in 19 post-pubertal patients. The age at the time of assessment ranged from 12 to 29 years-old and the mean follow-up was 162.9 months. Eleven patients rated the hardness of their erections as completely hard and very rigid, 6 as hard enough for masturbation but not completely hard, and 2 as hard but not hard enough to masturbate. Overall, 84% of patients reported being satisfied with the general appearance and straightness of their penis and 63% of patients had acceptable HOSE scores. On physical exam, it was determined on a non-erected, flaccid penis that a straight phallus with good cosmesis was achieved in 79% of patients (table 1).

Conclusions: Corporal body grafting with 1-ply SIS for correcting severe chordee in proximal hypospadias provides reliable short-term results that are preserved in the long-term, and assure a decent cosmesis and sexual function in the post-pubertal patient.

Source of Funding: None