PREOPERATIVE DIAGNOSIS: Chordee with mild hypospadias.

POSTOPERATIVE DIAGNOSIS: Chordee with mild hypospadias.

PROCEDURE PERFORMED: Correction of chordee with circumcision.



INDICATIONS FOR PROCEDURE: This is a 2-year-old boy who was born with

chordee with penile torsion to the right side and mild hypospadias. It

was decided that his hypospadias did not need to be repaired.

DESCRIPTION OF PROCEDURE: Following satisfactory induction of general

anesthesia, the abdomen and genitalia were prepped with Betadine

solution. He was draped in the usual manner. The penile adhesions were

lysed and the penis was re-prepped with Betadine solution. A 5-0

Prolene traction stitch was placed through the dorsum of the glans penis. A

circumferential incision was made 1 cm proximal to the coronal sulcus.

The penis was degloved at the level of Buck's fascia laterally and

dorsally, whereas ventrally, the skin was dropped back at the level of

the dermis. The urethra appeared to be relatively well vascularized.

When the penis was completely degloved, hemostasis was achieved.

Next, a dorsal incision was made in the foreskin to the midportion of

the penis. The foreskin flaps were transferred ventrally on each side

of the penis. The Byars flaps were transferred and the penile skin was

distributed evenly around the penis. A 5-0 fast absorbing gut was

placed between the vertex of the dorsal penile skin incision and the

mucosal skin distally. At this point, the penile shaft appeared

straight with no torsion or ventral curvature. A midline incision was

made in the ventral penile skin and a midline ventral skin closure was

preformed with interrupted 5-0 fast absorbing gut after redundant

foreskin was excised. The penile skin was sutured to the distal mucosal

skin with interrupted running 5-0 fast absorbing gut.

Next, at the request of the anesthesiologist, a penile nerve block was

performed with 0.25% Marcaine.

Xeroform gauze was applied and the patient was brought out of general