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Pediatric Urology

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Congenital Penile Anomalies

What Is Penile Chordee?

Chordee is a congenital (present at birth) abnormality that causes the penis to bend. In boys with chordee, the underside of the penis is bent downward or to the side. There are usually three main penile defects:

  1. Chordee (curvature)
  2. Shortened urethra that is not in the correct location on the head of the penis (it can be anywhere on the head or shaft of the penis)
  3. Dorsal penile hood (deficient foreskin on the head of the penis)

If your child has chordee associated with hypospadias, the curvature can be corrected during the hypospadias repair.

Chordee Without Hypospadias

While chordee usually occurs with hypospadias, it sometimes presents by itself. This happens in about 4 percent to 10 percent of boys who are affected by chordee. Isolated chordee, without hypospadias, is often associated with a hooded foreskin. This happens when there is a lack of foreskin on the underside of the penis.

Even though chordee can occur on its own, if it is seen on exam once your child is born, your pediatrician may refer you to a urologist and defer circumcision (if desired) until hypospadias can be ruled out.

Diagnosing and Treating Chordee

Chordee is more easily seen when your child has an erection. You may be asked about this when you come in for your appointment. We try to grade the significance of chordee in “degrees of curvature,” such as 45 degrees, 90 degrees, etc.

Typically, mild bending can be monitored and surgery is not needed. If your child’s penis bends significantly, especially with erections, or if the urine stream is affected, surgery may be recommended. Correcting these issues while the child is young can prevent urine stream issues or sexual dysfunction later in life.

What Is Penile Torsion?

Penile torsion is a curvature anomaly where the penis appears to be rotated or turned, usually counterclockwise. Torsion is usually associated with chordee and other penile, scrotal, or urethral anomalies. However, in about 25 percent of boys who are affected, penile torsion occurs by itself.

In the majority of penile torsion cases, the condition does not cause any harm or symptoms to the child, and surgery is not needed. In more severe cases of torsion, the penis may be rotated 90 degrees and can be associated with lateral chordee (curvature to the side), which can cause problems directing the urine stream. For boys with significant penile torsion, surgery is usually recommended.