Ano-Scrotal Distance (ASD) : Is it a marker for the severity of chordee?

• Published in: Journal of pediatric urology Vol. 17; no. 5; pp. 670.e1 - 670.e5
• Main Authors: Wirmer, Johannes, Sennert, Michael, Hadidi, Ahmed T.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-10-2021
• Subjects: Ano-scrotal distance urologic surgical procedures; Chordee; Hypospadias; Male; Penis; Urethra; Male; Urethra; Penis; Ano-scrotal distance urologic surgical procedures; Hypospadias; Chordee
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2021.06.010

To evaluate the relation between ASD and the severity of chordee and hypospadias in a referral center.
The distance between the anal verge and proximal scrotal edge (ASD) was measured in hypospadias patients between 6 and 18 months between 2016 and 2020 in the operating room under anaesthesia. Patients older than 36 months and younger than 6 months were excluded. The patients were classified according to meatus into: Grade I (glandular or chordee without hypospadias), II (distal), III (proximal) and IV (perineal). Chordee was assessed by erection test and classified into 2 groups; Group I: no chordee or mild chordee <30 and Group II: with severe chordee >30. Short ASD was defined as ≤ 2.0 cm.
817 boys were included. The patients were classified according to the hypospadias grades I (180 pt), II (415 pt), III (120 pt) and IV (102 pt). The median ASD for group I was 3.07 cm (range 1.0–5.5), for group II 3.10 cm (range 1.5-5.0), for group III 2.40 cm (range 1.5–54.5) and for group IV 2.10 cm (range 1.0–3.5).
The average ASD of the patients in Grade III and IV (2.26 cm) was significantly shorter than the average ASD of the patients in Grade I and II (3.09 cm) (p < 0.05). 184 patients had an ASD ≤2.0 cm. 38% of patients with glanular hypospadias (grade I) with ASD ≤ 2.0 cm had severe chordee.
This study shows that short ASD is a helpful marker of the severity of chordee and hypospadias. Patients with glanular hypospadias and short ASD have 38% chance of having severe chordee.