Chordee: Varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology

Objectives. Consensus has not been established as to the best treatment of congenital chordee. Outcomes analysis of treatment options are limited by t he prevailing use of ambiguous terminology. We sought to clarify the freque ntly used term "significant chordee" and to measure the utilization of curr ent treatment strategies. Methods. A survey covering current practice patterns concerning congenital chordee with hypospadias was sent to 236 members of the American Academy of Pediatrics, Section of Urology. Results, Correction of chordee was the primary concern in hypospadias surge ry of 31 % of those responding, but it was not the primary goal of 54% of r espondents. Findings indicate that "significant chordee" is clinically defi ned as curvature greater than 20 degrees, in that 75% of respondents said t hey would proceed with further intervention. Placement of plicating sutures was the most common therapy chosen for 20 degrees chordee, with 50% of res pondents electing this approach. Consensus was reached at 30 degrees chorde e, with greater than 99% intervening at this degree of curvature. At 30 deg rees curvature, 48% used an incisional Nesbit procedure. As the degree of c urvature increased, division or mobilization of the urethral plate became t he most common intervention. With 50 degrees chordee, urethral plate manipu lation was used 34% of the time. Sixty percent of the respondents believed the urethral plate did not often contribute to chordee. Conclusions. "Significant chordee" was believed to be a curvature greater t han 20 degrees to 30 degrees. With 20 degrees, 30 degrees, and 40 degrees c hordee, correction was most often approached dorsally. With 50 degrees chor dee, 54% approached the problem ventrally. We hope to encourage the use of more objective measurements and terminology. Objective measurements and lon g-term follow-up will improve our understanding of the natural history of c hordee and improve outcomes analysis. (C) 1999, Elsevier Science Inc; All r ights reserved.