Etiology, management and surgical complications of congenital chordee without hypospadias

Purpose: We comprehensively evaluated the etiology, management and surgical complications of chordee without hypospadias. Materials and Methods: We reviewed the records of patients who underwent chordee correction between January 1985 and December 1996. A total of 87 patients with a median age of 14 months were treated for chordee without hypospadias. Mean followup was 10 months. Patients were treated in the standard fashion and a straight phallus was confirmed in all postoperatively. We grouped cases according to the etiology of chordee, including skin tethering, fibrotic dartos and Buck's fasciae, corporeal disproportion and urethral tethering. Results: Of the 87 patients 28 (32%) were successfully treated with release of the skin and superficial fascia. In 29 cases (33%) extensive resection of the fibrotic dartos and Buck's fasciae was necessary to straighten the phallus, including 2 (7%) in which chordee recurred. Corporeal disproportion was identified in 24 patients (28%), of whom 2 (8%) also had complications (urethrocutaneous fistula and recurrent chordee in 1 each). In 6 cases (7%) urethral tethering was the etiology of chordee, of which 3 (50%) had complications (urethrocutaneous fistula and recurrent chordee in 2 and 1, respectively). Overall 80 of the 87 patients (92%) were successfully treated with 1 operation. Conclusions: In our series the etiology of chordee without hypospadias was evenly divided among skin tethering, fibrotic dartos and Buck's fasciae, and corporeal disproportion. A congenitally short urethra was a rare cause of isolated chordee. Surgical correction is highly successful with a low 8% complication rate.