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 6-18 months between 2016-2020 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.