Surgical treatment of chordee without hypospadias.

OBJECTIVE: The aim of this study was to retrospectively assess the efficacy of the surgical techniques commonly used in three types of chordee without hypospadias (Devine and Horton classification). METHODS: Twenty-six patients, ranging in age from 3 to 14 years, had chordee without hypospadias and underwent Nesbit dorsal plication (9 cases out of 12, type III), associated extensive mobilization of the urethra (10 cases out of 10, type II), and vascularized neourethra (3 cases out of 4, type I). RESULTS: Eleven subjects undergoing follow-up investigation for the milder forms of chordee were satisfied with the outcome achieved; there was no impediment of any kind in the sex lives of 5 adult subjects. Of the 11 patients undergoing follow-up after more complex surgery for Devine and Horton type I-II chordee without hypospadias, a residual abnormal curvature was present in 4 subjects. These patients were submitted to one or more reoperations with outcomes defined as satisfactory. CONCLUSION: To avoid the risks of persistent chordee, the authors suggest more radical and accurate operations for the treatment of type I and II pseudohypospadias.

[Unusual anorectal anomalies. A clinical contribution]. / Anomalie anorettali rare. Contributo clinico.

Anorectal malformations (ARM) include a spectrum of anomalies which have been subdivided as "high", "intermediate" and "low"; a fourth group, defined as "miscellaneous", collects the forms which are most rarely observed. It is important, for a specialist, to know the last ones under the diagnostic and/or therapeutic profile. In this paper, the various problems observed in five cases of ARM considered particularly rare are analysed: a case of anorectal agenesia with recto-cloacal fistula and short uro-genital sinus; a rectal atresia with normal anal canal; a case of anorectal stenosis; an incomplete anal membrane; an anal agenesia with scrotal fistula.

[Rare anorectal malformations. Intermediate-type anal agenesis with a rectocutaneous fistula]. / Malformazioni anorettali rare. L'agenesia anale di tipo intermedio con fistola retto-cutanea.

A case of anal agenesia with recto-cutaneous fistula is presented. The recto-cutaneous fistula in an intermediate or high anomaly seldom noticed so that it is not included in the common classifications. The surgical approach performed by us was that described by Mollard. The anterior perineal pull-through, under proximal protective enterostomy, allow to reduce the rate of postoperative complications and sequences and obtain--as in our patient--a normal continence and sphincteric function with an excellent esthetic outcome.