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S14-4
(PP)
CAN SEPARATION OF THE SCROTAL SAC PREDICT THE NEED FOR URETHRAL
PLATE TRANSECTION IN PROXIMAL HYPOSPADIAS?
Luke HARPER
1
and Alexis ARNAUD
2
1) CHU F Guyon, Pediatric Surgery, Saint-Denis De La Réunion, FRANCE - 2) CHU Rennes, Pediatric Surgery, Rennes,
FRANCE
PURPOSE
The main challenge in proximal hypospadias repair is correcting curvature, which in some cases requires urethral
transection. Some authors report extensive dissection of the urethral plate before deciding whether the plate needs to
be transected or not, whilst techniques such as the Koyanagi, commit to urethral plate transection from the start.
Having a reliable pre-dissection marker of the need for urethral transection would be useful in choosing a technique.
Meatal position alone is unreliable and correct assessment of division of the corpus spongiosum requires complete
degloving. We wanted to determine if presence of marked separation of the scrotal sac (SSS), also known as bifid
scrotum, could help predict the need for urethral plate transection.
MATERIAL AND METHODS
We prospectively enrolled a series of boys with severe proximal hypospadias. We noted the presence of SSS. During
surgery, we fully degloved the penile skin shaft, freeing all ventral tissues, and radically dissected the more proximal
bulbar urethra. We then performed an erection test. If there was residual curvature <30° we performed a dorsal
plication, if it was >30° we transected the urethral plate.
RESULTS
Twenty-nine patients, of which 18 presented SSS, were included. Using our methodology, we estimated transection of
the urethral plate to be necessary in 15 out of the 18 children with SSS, and 2 out of the 11 children without SSS. The
relative risk for requiring urethral plate transection in presence of SSS was 4.6.
CONCLUSIONS
We believe presence of SSS reflects the degree of ventral tissue hypoplasia and could be a marker for the need for
urethral plate transection.