Multiple dorsal midline plication (MDMP) for correction of Donnahoo type III chordee in postpubertal patient

Objective To evaluate the role of multiple dorsal midline plication (MDMP) procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient. Methods From September 2010 to July 2013, 33 postpubertal patients with Donnahoo type Ⅲ chordee (>20°) were treated with MDMP procedure. The age ranged from 18 to 37 years with an average of 29 years. Primary surgery was indicated in 18 patients including type Ⅲ chordee in 11 and type Ⅲ/Ⅳ in 7, with associated hypospadias in 12. Redo surgery was warranted in 15 patients including type Ⅲ chordee in 13 and type Ⅲ/Ⅳ in 2, with associated urethral defects necessitating repair in 12. Intraoperative artificial erection was induced to confirm the degree and length of chordee. Longitudinal plication sutures, 4 dots each, were applied close to the midline in a parallel fashion on each apex of curvature, to achieve satisfactory orthoplasty with 16-dot to 64-dot plication according to the chordee status, and the urethral repair indicated was achieved simultaneously. Results Satisfactory orthoplasty was achieved with 16-dot plication in 16 patients, 24-dot in 10, 32-dot in 6, and 64-dot in 1 patient whose penile curvature was severe and long. Followup was obtained from 35 to 69 months with an average of 46 months. Three patients lost of followup. Urethroplasty-related complications were noted in 5 patients including urethrocutaneous fistula in 2, urethral dehiscence in 1, urethral diverticulum in 1, and urethral stricture in 1. Mild cicatrical curvature (less than 15 degree) was noted in 2 patients. No postoperative priapism, erectile dysfunction, and paraesthesia was noted, nor chordee recurrence. Conclusions When applied appropriately, MDMP is an effective procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient with good and long-standing orthoplasty. Key words: Hypospadias; Donnahoo type Ⅲ; Chordee