LATE-ONSET RECURRENT PENILE CHORDEE AFTER SUCCESSFUL CORRECTION AT HYPOSPADIAS REPAIR

Purpose: Artificial erections are induced at hypospadias repair to pre vent recurrent chordee. We describe the development and etiology of la te onset recurrent chordee greater than 10 years after the initial sur gery. Materials and Methods: We reviewed the medical records of 22 pat ients with a median age of 4 years at surgery who were referred for ev aluation of chordee 10 years after successful hypospadias repair. Resu lts: Of the 22 patients with recurrent chordee 13 had penoscrotal and 9 had proximal penile hypospadias at the initial operation. All origin ally required corporoplasty for the release of chordee, including Nesb it procedure in 19 and tunica vaginalis graft in 3. Successful artific ial erections were induced after corporoplasty in all cases. Urethral reconstruction was performed with full-thickness preputial free grafts in II cases, bladder mucosal grafts in 7 and transverse island flap u rethroplasty in 4. Although chordee developed during puberty (median a ge of onset 16 years, range 12 to 18), the median age at presentation for surgical correction was 21 years. Recurrent chordee was due to ext ensive fibrosis of the reconstructed urethra in 7 cases (32%), corpore al disproportion in 8 (36%) and both conditions in 7 (32%). Conclusion s: A successful artificial erection induced at hypospadias surgery doe s not prevent the delayed onset of recurrent chordee. Recurrent chorde e may be secondary to the redevelopment of corporeal disproportion and /or extensive urethral fibrosis.