Ventral lengthening is preferable to combined ventral lengthening and dorsal plication for penile length in hypospadias with severe ventral curvature

TL;DR

This study finds that ventral lengthening alone is better than combining it with dorsal plication for increasing penile length in severe hypospadias cases.

Contribution

The study introduces two new metrics, PLR and CPLR, to evaluate penile lengthening effectiveness in hypospadias surgery.

Findings

Ventral lengthening alone provides better penile elongation than combined ventral lengthening and dorsal plication in severe curvature cases.

For patients with curvature degree after degloving over 45°, the CPLR was significantly higher in the ventral lengthening group.

Proximal hypospadias patients also showed better outcomes with ventral lengthening alone.

Abstract

This study aims to compare the effects of ventral lengthening (VL) versus ventral lengthening combined with dorsal plication (VL + DP) techniques on penile length in hypospadias. Clinical data were retrospectively collected from patients who underwent hypospadias repairs with urethral plate transection between March 2017 and June 2023. Patients were divided into VL group and VL + DP group based on the curvature correction techniques. Two novel parameters—penile lengthening ratio (PLR) and curvature-adjusted penile lengthening ratio (CPLR)—were introduced to evaluate the effectiveness of penile lengthening. A total of 103 male patients with hypospadias and severe ventral curvature were included. In patients with a curvature degree after degloving (CDAD) greater than 45°, the CPLR was significantly higher in the VL group compared to that in the VL + DP group (0.0101 ± 0.0028 vs. 0.0085 ± 0.0024, p = 0.026). Among patients with proximal hypospadias, the CPLR in the VL group was significantly higher than that in the VL + DP group (0.0106 ± 0.0024 vs. 0.0093 ± 0.0026, p = 0.041). In patients with CDAD > 45° or proximal hypospadias, VL demonstrated superior penile elongation compared to VL + DP.

Figures