Efficacy of Three Corporotomies to Correct Ventral Penile Curvature in 400 Patients With Severe Hypospadias

Three ventral corporotomies alone corrected penile curvature in 81% of cases; adding one dorsal plication pushed success to 99% across 400 patients

Journal: Journal of Pediatric Urology | Published: 2026-01-13 | Type: Retrospective Case Series | PMID: 41621232 Authors: Warren Snodgrass, Nicol Bush (Hypospadias Specialty Center, The Colony, TX — a private specialty practice) Funding/COI: Funding not reported. Authors declare no conflicts of interest.

Summary

This retrospective series from a single high-volume specialty center reports outcomes for 400 patients — 237 primary and 163 reoperative — with proximal hypospadias and ventral curvature (VC) of 30–135°, all treated with a three-stage repair (STAC). Three ventral corporotomies during stage one corrected curvature in 81% of patients; a single Heineke-Mikulicz dorsal plication at stage two resolved most residual cases, bringing the total to 99% corrected by artificial erection (AE) assessment. The study adds meaningful volume data to a surgical technique the authors have championed at their own center.

Claims

• Mean VC was 74° in primary cases (median 75°); 85% had VC greater than 30–45°; 25% had VC greater than 90°
• Reoperative cases had lower mean VC (54°, median 50°; p < 0.00001)
• 81% of patients had no residual VC at stage two after corporotomies alone
• Residual VC was always ≤30° and was more common in those with initial VC >90° (p < 0.00001)
• 99% achieved confirmed straightening by final AE, at a mean of 17 months post-procedure (range 11.5–58 months)
• Zero bleeding complications requiring intraoperative or postoperative intervention
• One adult patient (Tanner stage 4–5) self-reported a 15% decrease in erection fullness

Study Quality

This is a retrospective, single-center, non-comparative case series — the lowest rung of surgical evidence outside a case report. There is no control arm, no randomization, and no comparison against alternative corporotomy techniques or grafting approaches. Outcomes depend entirely on the surgical skill of two surgeons at a center that specializes in exactly this procedure, which limits generalizability to community or general pediatric urology settings.

The primary outcome — curvature confirmed by AE — is an objective intraoperative measure, which is a strength. However, AE timing varied widely (11.5 to 58 months), and longer-term functional outcomes for the pediatric patients will not be known for years. Erection quality data was collected only for a subset of sexually mature patients and reported as a single self-report, with no validated instrument.

Red Flags

• No comparison group — impossible to know if three corporotomies outperform two, or grafting, or any alternative
• Single institution with specialist selection bias: patients referred to a hypospadias-only center are not representative of the general hypospadias population
• Authors operate the center whose technique is under evaluation — institutional investment even absent financial COI
• Funding source not disclosed for a center that charges for procedures
• Erection quality outcomes are anecdotal for the few adult patients; no validated PRO instrument used
• Reoperative cases mixed with primary cases in the 400-patient denominator without stratified outcome reporting
• Follow-up window spans 11.5–58 months with no standardized endpoint — shorter follow-ups may miss late recurrence

Strengths

• 400 consecutive patients is a large cohort for proximal hypospadias, a condition rare enough that most series number in the dozens
• AE repeated at multiple operative stages provides objective documentation beyond single-point assessment
• Includes reoperative cases, which are often excluded from technique series
• Zero bleeding complications is a meaningful safety signal across this volume
• Transparent about the 19% residual rate after corporotomies alone, rather than reporting only the final 99% figure

Verdict

For a rare pediatric condition, a 400-patient series is genuinely useful volume — and the repeated AE methodology is more rigorous than the subjective reporting common in smaller hypospadias series. But this is a specialist center reporting its own technique with no comparator, no standardized follow-up, and no functional outcomes beyond one adult's self-report. The 99% headline should be read as "99% had no curvature detectable by AE at this center, in the hands of these two surgeons, at the time of the next stage." Whether that translates to durable functional outcomes at 10 or 20 years, or replicates in general practice, this paper cannot answer.