Chordee correction by corporal rotation: The split and roll technique

Purpose: The optimal approach to correcting ventral chordee associated with severe hypospadias is controversial. Dorsal plication tends to shorten the phallus and ventrally positioned grafts often mandate a staged procedure. An alternative approach is presented using corporal rotation to correct ven tral chordee associated with hypospadias. Materials and Methods: In 6 boys with severe hypospadias the urethral plate was divided and the septum between the corpora cavernosa was partially spl it with a ventral midline incision. This incision facilitates corporal rota tion. Access to the dorsal aspect of the corpora cavernosa was achieved by dissecting Buck's fascia with its encased neurovascular bundles, so that th e bundles in the area of chordee were completely elevated and preserved. Us ing artificial erection as a guide nonabsorbable sutures were placed in the area of maximal curvature from the dorsolateral aspect of 1 corpus caverno sum across the midline to the other side such that, as the knots were tied, the corpora rotated toward the dorsal midline. The knots were buried by ap position of the rotated corporal bodies. Results: Excellent straightening of the phallus was achieved intraoperative ly in these patients. Conclusions: The split and roll technique for correcting severe chordee doe s not require incisions into the corporal substance, involve use of grafts or cause shortening of the phallus. The neurovascular bundles are preserved and are not compressed by the rotational sutures. The surgeon may perform 1-stage reconstruction while achieving maximal penile length.