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The Urethral Plate and Chordee

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Hypospadias Surgery

Abstract

The urethral plate is the precursor of the penile urethra. Glenister defined the urethral plate as an outgrowth from the anterior wall of the urogenital sinus. Paul and Kanagasuntheram defined it as the moist pink gutter of mucous membrane with well-defined muco-cutaneous line and extends from the urethral orifice to the base of the glans penis. Duckett defined it as the skin and spongiosal tissue which lies distal to the urethral meatus in a hypospadias and goes out onto the ventral glans. The urethral plate may present in different degrees of differentiation, hypoplasia, width, and length. The histological structure, histochemical and electron microscopic picture of the urethral plate, and the underlying tissues causing chordee is presented.

Chordee may be classified into mild, moderate, and severe. Assessment of chordee is performed by erection test and the angle is measured using a goniometer or the “Angle Meter App” Ventral degloving is usually sufficient for mild chordee. Dorsal plication may be used to correct curvature less than 30°. Division of the urethral plate is indicated with persistent curvature more than 30°. Tunica albuginea longitudinal excision (TALE), multiple superficial corporotomies (fairy cuts), incision of the tunica albuginea, and graft or flap are among the techniques commonly used to correct severe, deep chordee.

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Abbreviations

AAP:

American Academy of Pediatrics

ASD:

Anoscrotal distance

CEDU:

Chordee excision and distal urethroplasty

EMC:

Extracellular matrix component

H/E:

Hematoxylin/Eosin

HIS:

Hypospadias International Society

SIS:

Small intestinal submucosa

SLAM:

Slit-like adjusted Mathieu

SMA:

Smooth muscle actin

STAC:

STraighten And Close

STAG:

Staged tubularized autograft

TALE:

Tunica albuginea longitudinal excision

TAP:

Tunica albuginea plication

TEM:

Transmission electron microscopy

TITA:

Transverse incisions into the outer tunica albuginea

TVF:

Tunica vaginalis flap

UVI:

Unaided visual inspection

VC:

Ventral penile curvature

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  1. Hypospadias Center and Pediatric Surgery Department, Sana Klinikum Offenbach, Academic Teaching Hospital of the Johann Wolfgang Goethe University, Offenbach, Frankfurt, Germany

    Ahmed T. Hadidi

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  1. Hypospadias Center and Pediatric Surgery Department, Sana Klinikum Offenbach, Academic Teaching Hospital of the Johann Wolfgang Goethe University, Offenbach, Frankfurt, Germany

    Ahmed T. Hadidi

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Hadidi, A.T. (2022). The Urethral Plate and Chordee. In: Hadidi, A.T. (eds) Hypospadias Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-94248-9_8

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