Hypospadias Chordee Correction

Hypospadias chordee correction surgery India

• Hypospadias is a birth defect in which the opening of the urethra (the pipe through which one urinates) is on the underside, not at the tip, of the penis.
• Chordee is the downward bending of the penis that usually occurs with hypospadias due to fibrous tissue or skin that is adherent in a way that is abnormal.
• Chordee correction is also a critical procedure during the repair of hypospadias so that the penis is straight and functional for future normal urination and sexual function.

Purpose of Chordee Correction Surgery

• To straighten the penis by excising fibrotic tissue or tightening abnormal skin.
• To achieve normal function of the penis for urination and future sexual activity.
• To set up for urethral reconstruction (in single-stage or two-stage hypospadias repair).

Procedure Steps

The operation is usually carried out under general anaesthesia. It can be performed as a single-staged chordee correction or as part of a staged repair of hypospadias depending on severity.

Step 1: Degloving of the Penis

• The skin is gently liberated all around the shaft in order to expose the underlying tissue and to assess the extent of the curvature.

Step 2: Assessment of Curvature

• An artificial erection test through saline injection assists the surgeon in assessing the bend of the penis.

Step 3: Correction of Chordee

According to severity:

• Mild curvature (<30°): Corrected by skin release and degloving.
• Moderate curvature (30–60°): Corrected by excision of fibrous tissue or dorsal plication (Nesbit technique).
• Severe curvature (>60°): May involve urethral plate transection and reconstruction (two-stage repair).

Step 4: Urethral Reconstruction (if needed)

• In single-stage surgery, urethra is reconstructed following chordee correction.
• In serious cases, stage 1 repairs chordee and stage 2 (at 6–12 months) reconstitutes the urethra.

Step 5: Dressing and Catheter Insertion

• A tiny urinary catheter (stent) is inserted for 7–14 days to facilitate urine flow during healing.

Duration and Hospital Stay

• Surgery duration: 1.5 to 3 hours (depending on the severity).
• Hospital stay: Typically 1–3 days.
• Complete recovery: 2–3 weeks, with follow-up for many months.

Chordee correction and urethroplasty India

• Chordee repair straightens the penis by removing abnormal fibrous tissue that causes downward curvature.
• Urethroplasty rebuilds or forms a new urethral tube so the urinary opening (meatus) is at the tip of the penis.
• These two procedures together restore both the normal function and appearance of the penis — allowing for normal urination and subsequently, later sexual function.

Indications

This two-stage procedure is done for:

• Hypospadias with chordee (most common indication)
• Severe penile curvature secondary to congenital tissue shortening
• Failed previous repairs of hypospadias
• Penile scarring or trauma resulting in curvature or urethral defect

Surgical Steps

The operation is performed under general anaesthesia, usually in infants aged 6–18 months.

Step 1: Penile Degloving

• The penis is degloved (skin stripped) to reveal underlying tissues and measure curvature.

Step 2: Artificial Erection Test

• Saline is injected into the penis to determine the extent of curvature.

Step 3: Chordee Correction

Depending on severity:

• Mild curvature (<30°): Corrected by skin release and degloving.
• Moderate curvature (30–60°): Fibrotic tissue excision or dorsal plication (Nesbit or modified technique).
• Severe curvature (>60°): Urethral plate transection and straightening.

Step 4: Urethroplasty (Urethral Reconstruction)

• Once the penis is straightened:
• If mild–moderate hypospadias: A tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) may be performed using the existing urethral plate.
• If severe hypospadias: A two-stage urethroplasty is performed —
• Stage 1: Chordee repair and grafting (from inner prepuce or buccal mucosa).
• Stage 2 (6–12 months later): Tubularization of the graft to create the new urethra.

Step 5: Glans and Skin Reconstruction

• The glans (penile head) is reformed around the new opening of the urethra, and skin is redraped in a neat fashion.

Step 6: Catheter Placement and Dressing

• A small urinary catheter (stent) is retained for 7–14 days for draining urine and aiding healing.

Duration and Hospital Stay

• Surgical time: 2–4 hours (severity-dependent)
• Hospital stay: 2–4 days
• Recovery: 3–4 weeks (with follow-up for several months)

Postoperative Care

• Maintain dressing clean and dry.
• Catheter/stent removed after 7–14 days.
• Antibiotics and pain medication given.
• No tight diapers or clothing on infants.
• Follow-up to observe healing and urine flow.

Best hospital for hypospadias chordee repair India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Factors Affecting Chordee correction procedure cost India

Following are the key factors influencing the cost of chordee correction + urethroplasty (hypospadias + chordee surgery) in India:

Severity and Type of Hypospadias / Chordee

• More severe conditions necessitate more complicated surgery (more degree of curvature, longer urethral defect, requirement for grafts, two-stage repair). Graft surgeries (e.g. buccal mucosa), or repair of severe curvature, or re-do surgeries are costlier. This is one of the largest cost factors.

Single-stage vs Two-stage Surgery

• If urethroplasty + chordee repair is possible in a single stage ("single-stage"), it's more cost-effective in terms of number of surgeries, hospital stay, and surgeon & anaesthesiologist charges. Severe urethral strictures invariably need staged repair (first stage to fix chordee and place graft, second stage afterwards), which adds expense.

Surgeon's Expertise and Reputation

• Surgeons with greater experience, pediatric urology specialty, or good results will have higher fees. Also, complicated procedures need more experienced team, prolong may use more OR time.

Hospital Type and Infrastructure

• Tier-1 speciality hospital with high-tech OT, neonatal/pediatric support, ICU facilities, better sterilization, etc., will be more expensive. NABH accredited hospitals tend to be more expensive.

Location / City

• In metros (Delhi, Mumbai, Bangalore, Chennai, etc.), fees are more than in small cities. Infrastructure charges, property costs, employee wages etc., are more in large cities.

Room Category / Hospital Stay Duration

• Private rooms or deluxe ward charges more than common rooms or wards. Longer hospital stay (due to complications or severity) incurs room-charges, nursing, food etc.

Anaesthesia and Operating Theatre Charges

• More complicated cases are time consuming OR take more time; require more sophisticated anaesthesia; may require special equipment or microsurgical instruments. All these add up to OT + anaesthesia charges.

Use of Grafts / Special Materials

• If grafts (e.g. skin, inner-foreskin, buccal mucosa) are used by the surgeon, special sutures, or specialized tissue/buffer flaps, it adds to cost. Also specialized instruments if required.

Preoperative Investigations & Diagnostics

• Blood work, imaging, and any pre-op testing. If co-morbid conditions must be screened for (heart, kidneys etc.), that is extra, and any pre-op hospital stay or prep.

Postoperative Care & Follow-ups

• Dressings, meds, stent/catheter care, monitoring, potential cost of treating complications (e.g. fistula, infection). Follow-up visits incur travel/time expense.

Complications

• If it does not work out (e.g. leak, infection, revision required), cost rises as a result of additional surgery, longer in-hospital stay, additional drugs, etc.

Hospital Accreditation and Brand

• Better-known hospitals / centres of excellence charge more. Accreditation (quality certifications) is associated with increased cost.

Patient's Overall Health / Co-morbidities

• If the child has any other medical problems (e.g. bleeding disorder, heart disease, etc.), surgery is more risky/complicated, needs greater monitoring, therefore costlier. Also, risk of anaesthesia increases.

Pediatric hypospadias chordee surgery India

Hypospadias: A birth defect in which the opening of the urethra is found on the underside of the penis rather than on the tip.

• Chordee: Curvature of the penis due to fibrous tissue attachment.
• Pediatric consideration: In most cases, surgery is done on an infant or young child (6–18 months) to allow normal growth, function, and cosmetic appearance.

Purpose of Surgery

• Straighten the penis (chordee correction) for normal urinating and sexual function later.
• Rebuild the urethra (urethroplasty) so that the opening for urine is at the tip.
• Enhance aesthetic appearance and avoid psychological or functional problems.

Conclusion

Pediatric hypospadias with chordee is a frequent congenital urethral and penile curvature disorder. Penile straightening, urethral reconstruction, and normal urination, with a cosmetically appealing appearance, are the goals of surgical repair. Early treatment (usually 6–18 months) offers the optimal results of growth, function, and psychosocial well-being. The operation may be single-stage or staged, based on the degree of hypospadias and chordee. Success rates are excellent (functional: 90–95%, cosmetic: 85–90%) if done by skilled pediatric urologists. Postoperative follow-up and care are imperative to observe healing, urinary function, and complications. Most children will have normal urinary function, straight penile anatomy, and acceptable cosmetic outcomes with competent surgical treatment, promoting healthy and normal growth.

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FAQ

At what age must it be performed?

• Best age is 6–18 months when there is better healing, growth, and cosmetic results.
• It can be performed later, but early repair is ideal.

Is surgery always necessary?

• The majority of hypospadias cases accompanied by chordee need surgery to straighten the penis and rebuild the urethra
• Mild cases with minimal curvature can sometimes be observed.

What kinds of surgery are performed?

• One-stage repair: Chordee correction and urethroplasty in a single operation (in mild/moderate cases).
• Two-stage repair: Severe cases demand two operations — one to straighten the penis, then to rebuild the urethra using a graft.

Will my child have a normal urinary stream?

• In most instances, yes. Urethroplasty aims to form a normal urethral opening at the end of the penis.

Is the penis likely to grow normally?

• Yes. Early surgery usually permits normal growth of the penis. Long-term follow-up prevents recurrence of curvature at puberty.