The Corporotomy and Dermal Graft Procedure: The Case for Severe Curvature

The Corporotomy and Dermal Graft Procedure technique is suggested for complex hypospadias forms associated with severe curvature. In cases with more than 30 degrees of ventral curvature, we believe that the disproportionate ventral/dorsal length of corpora cavernosa is a major limiting factor for more conservative procedures, such as dorsal plication, including Baskin and classical Nesbit procedures lifting the neurovascular bundle. The so-called “fairy cuts” procedure, which is based on more superficial parallel transverse ventral corporal incisions, has not passed the test of time and the fear of retraction and recurrence of curvature limits its spread as a widely acceptable alternative technique. The corporotomy and the use of a dermal graft to restore corporal integrity is based on the concept of ventral corporal lengthening and mimics the strategy in Peyronie’s disease. It has the advantage of being versatile enough to treat all forms of severe curvature but normally requires a two-stage strategy for urethral reconstruction. In young children and babies, a tunica vaginalis flap is also acceptable to replace the dermal graft and correct the corporal defect, but for adolescents and teenagers, our preference is the use of dermal grafts obtained from the groin.