Chordee Excision and Distal Urethroplasty (CEDU) for Perineal Hypospadias

Perineal hypospadias correction has swung from two-stage repair in the 1960s to one-stage repair in the 1980s and back to two-stage repair in the 2000s. Here, we present our experience with a technique where Chordee Excision and Distal Urethroplasty (CEDU) are performed at the first operation leaving a 1–2 cm segment as perineal urethrotomy to be reconstructed at the second operation. The principle is to excise the hypoplastic urethral plate, atretic corpus spongiosum and longitudinal layer of tunica albuginea, (the TALE technique) split the glans in the midline and reconstruct a healthy urethral plate using preputial and lateral skin flaps to the tip of the glans. Distal urethroplasty was performed leaving 1 cm at the proximal end to be reconstructed 3–6 months later. Follow-up period ranged from 17 to 84 months (mean 60). Satisfactory results were obtained in 114 patients (90%). The CEDU technique diverts urine away from the urethroplasty for 3 months without a catheter. It reduces the hospital stay and patient discomfort. It produces satisfactory results and has become the standard technique for perineal hypospadias in the hypospadias center, Frankfurt since 2013.