Introduction: Concerns have been raised regarding the effectiveness and durability of transverse ventral corporotomies to reliably correct chordee. Herein, we assessed the outcomes of this technique to correct ventral curvature (VC) in severe penoscrotal hypospadias.

Methods: We selected 62 patients who underwent both stages of primary staged inner prepuce graft repair with a minimum six-month followup from a prospectively collected hypospadias database (2008–2021, n=881). Proximal TIP/Byars flaps cases and redos were excluded. VC was corrected by dividing the urethral plate in all cases and performing three transverse ventral corporotomies ± dorsal plication (80%). Residual VC was checked in all cases during the second stage. All procedures were performed by a single surgeon. Preoperative testosterone stimulation (PTS) was administered for glans width <14 mm (three intramuscular injections, three weeks apart). Age at each stage of repair, meatal location, degree of VC assessed before/after degloving with an artificial erection measured by photograph with an electronic app, anesthetic block (caudal/dorsal penile block), and complications (urethrocutaneous fistula [UCF], glans dehiscence [GD], recurrent VC, and graft contraction) were collected. Outcomes of interest were postoperative recurrent VC and overall complication rate. Recurrent VC was assessed by reflex erection during examination and/or parents reporting.

Results: Median patient age at first and second stage was 21 and 30 months, respectively; mean followup was 42 months. Eighty-four percent of patients had penoscrotal 45 (72%), scrotal 9 (15%), and perineal hypospadias 12 (13%). Overall, 35/62 (57%) patients had VC between 30–70° and 27 (43%) had >70° after degloving; 57/62(92%) boys received PHS (three shots). Grafts took well in most cases, with only four (6%) contractions. Of these, two needed re-grafting and two were stretched (vit. E). The median interval between stages was eight months. Overall, complications occurred in 15/62(24%) boys: nine UCFs, five GDs, and one recurrent VC due to skin tethering. All successful cases had the neomeatus located at the tip of the glans. Parents of three boys with GD decided for no further surgery, leaving the meatus at the corona. In total, the re-operation rate was 19% (12/62).

Conclusions: An overall re-operation rate of 19% was observed in patients who underwent staged preputial graft repair with three transverse corporotomies to treat scrotal/perineal hypospadias. This rate is significantly lower than what has been previously reported using staged Byars flaps procedures or single-stage operations. After a mean followup of almost four years, recurrent VC was seen in only one child (1.6%) due to skin tethering. Despite being the longest followup described with this technique thus far, we recognize that recurrent VC may not present until adolescence, therefore, following these patients until adulthood is imperative.