Penile Curvature (Chordee)
What is chordee?
The penis is normally straight, but in some cases it curves. This curvature is called chordee. It may be mild to severe and may be asymmetrical. It can result from short of the urethra (tube connecting the bladder to the penis) and usually associated with hypospadias. The curvature can be treated by surgery separately or at the same time of hypospadias surgery, but not all children need surgery.
Symptoms of chordee
Sometimes doctors look for chordee when they observe that hypospadias is present, usually at birth or soon afterward.
Many parents of boys who have chordee without hypospadias simply observe that the penis is “bent.” But almost all children with severe hypospadias associated with some degree of Chordee.
Penile torsion (wandering raphe).
In some children the midline raphe (the ridge normally found on the underside of the penis) wraps around the penis. This “wrapping” can pull the penis into a downward angle. If the torsion (or pulling) is close to 90 degrees or more, physicians may recommend surgical correction. Doctors usually make this correction during circumcision.
In some cases of skin tethering the urethra is paper-thin near the tip of the penis. Doctors may use one or more surgeries to first create a hypospadias to permit the urethra to be reconstructed, and then to repair the hypospadias. In other patients doctors use permanent sutures to straighten the penis.
In some cases of skin tethering the urethra is paper-thin near the tip of the penis. Doctors may use one or more surgeries to first create a hypospadias to permit the urethra to be reconstructed, and then to repair the hypospadias. In other patients doctors use permanent sutures to straighten the penis.
Occasionally the underside of the penis is fused with the scrotum. During circumcision the physician will release the penis from the scrotum. Also during the procedure the physician will use the foreskin to reconstruct the underside of the penis.
Dorsal preputial hood
This term simply means the foreskin does not cover the entire head of the penis. Instead it covers only the upper side. Often hypospadias and/or chordee go along with this condition. Physicians will evaluate for chordee or hypospadias before performing circumcision.
Treatment of chordee
Once the decision is made to surgically correct chordee, physicians evaluate the extent of chordee via an artificial erection while the child is asleep. This is performed by injecting sterile saline solution into the erectile tissues. If the degree of bending is greater than 30 degrees from a straight erection, physicians will surgically correct the curvature. Mostly the surgeon will correct hypospadias at the same time.