SINGLE AND MULTIPLE DERMAL GRAFTS FOR THE MANAGEMENT OF SEVERE PENILECURVATURE

Purpose: Conventional techniques result in chordee correction in the m ajority of patients. However, some with extensive chordee require furt her treatment to correct persistent extraordinary penile curvature. Ou r practice has been to treat this condition with interpositional derma l grafting. We review our experience with this procedure. Materials an d Methods: During a 5-year period dermal grafts harvested from the non hair-bearing inguinal skin fold were placed in 51 patients with a mean age of 29 months. The primary diagnosis was penoscrotal or perineal h ypospadias in 36 patients (hypospadias cripple in 4), the exstrophy-ep ispadias complex in 3, mid shaft or distal hypospadias with severe cho rdee in 10 and chordee without hypospadias in 2. A total of 49 patient s (96%) underwent staged urethroplasty. Results: One graft was placed in 29 patients (57%), 9 (18%) received 1 graft and underwent a Nesbit plication, (14%) received 2 grafts, 5 (10%) received 2 grafts and unde rwent dorsal plication, and 1 (2%) received 3 grafts;Second stage uret hral reconstruction was done using a Thiersch-Duplay tube in the major ity of cases. In 5 patients mild residual chordee was easily corrected at the time of second stage repair. Conclusions: In a staged repair t he first priority of the initial stage is to achieve a straight phallu s. While our experience indicates that a single dermal graft is suffic ient in approximately 57% of cases, when it does not result in complet e straightening, we have had success with placing additional graft(s) and/or performing dorsal plication. We believe that the additional pen ile length achieved with dermal grafting results in a dependent phallu s and cosmesis preferable to that of plication only.