Hypospadias is a condition present at birth where the urine duct is not at the tip of the penis but on the underside, often only mildly displaced, but sometimes all the way back toward the testicles.
This can result in problems with passing urine standing up, and it can also interfere with sexual function. As such, surgical correction of both chordee and hypospadias is recommended.
Surgery can be performed to straighten the penis and remove the fibrous tissue that is responsible for the bending. When properly corrected, it does not cause long-term problems, and a natural appearance of the penis is usually restored.
- Chordee without hypospadias is a relatively uncommon condition.
- Symptoms include a curved or bent penis - generally diagnosed shortly after birth.
- Causes are unknown.
- Surgery is the best treatment, particularly when carried out in infancy.
Symptoms and diagnosis
Chordee is frequently diagnosed in infancy. However, it may not become apparent in some cases until puberty.
Chordee is normally diagnosed shortly after birth when doctors observe hypospadias. In cases of chordee without hypospadias, the parents are the first to notice that the penis is curved.
Sometimes there is extra foreskin on the top of the penis, giving it a hooded appearance, which can be a sign that chordee is present.
Diagnosis is relatively simple and made by:
- a clinical examination of the penis
- the symptoms reported by the parents
Most cases are diagnosed within the first few months of the child's life, and treatment is typically scheduled for when the child is 6-18 months.
Chordee may not be diagnosed until after the boy reaches puberty, as the curvature becomes more apparent during erection. In such cases, surgery is still usually successful, but it can be more complicated.
Early intervention is preferred so that the individual does not develop insecurities or a negative body image later in life.
The precise cause of chordee is unknown.
The most common reason is that the penis does not develop properly in the womb. A skin defect, penis abnormality, or other defect is present that results in a curved appearance, which is most evident during erection.
A number of types of chordee have been classified. They include:
|Type||Scientific definition||Simplified meaning|
|1||Skin chordee||An irregular growth of tissue under the penis, which pulls it down toward the scrotum.|
|2||Fibrotic Buck's and dartos fascia||An irregular growth of tissue on the penile shaft surrounding the urine duct, which bends the penis downward, or more rarely to the left side (lateral curvature) or backwards toward the stomach (dorsal curvature).|
|3||Corpeal disproportion||A physical abnormality of the penis itself.|
|4||Congenital short urethra||The tube through which urine flows is unusually short (present for birth).|
Surgery is required to correct the penis and is carried out by a specialized doctor called a pediatric urologist. Surgery lasts 1-3 hours, and the person goes home the same day.
The procedure usually involves the following steps:
- First, an erection test is carried out to assess the extent of the curvature. This involves the injection of saline into the penis.
- The penis is then "degloved" to remove any excess skin that might be fastening the penis to the scrotum (type 1 chordee), and the erection test is repeated to confirm that the penis is straight.
- If the penis is still bent, any tissue around the urethra will be removed (type 2 chordee). Again the erection test will be performed.
- If the bend persists, it may be the result of a physical abnormality (type 3 chordee) and a procedure will be carried out at the site of the greatest curvature to make the longer and shorter sides of the penis equal in length.
- If the curve is due to a short urethra (type 4 chordee), it will be lengthened using tissue from the foreskin or another site on the penis.
- The erection test will be repeated after these procedures to confirm the penis is straight.
- Once the penis has been straightened, the foreskin will be repaired, or skin will be removed to give the penis a circumcised look.
Surgery to correct chordee will usually last from 1-3 hours, with the patient returning home on the same day.
When the infant returns home after surgery, parents are required to follow care guidelines provided by the doctors such as:
- following a liquid diet for at least 1 day after surgery
- keeping the bandage and surrounding areas clean
- giving the child sponge baths only for the first 7 days, ensuring that the penis stays dry
- giving the child short baths or showers regularly 1 week after surgery, especially after bowel movements
- making sure to thoroughly dry the child after bathing and using a blow dryer on the cool setting to help to dry the penis
- using double diapers on the child for added protection, and changing frequently
- ensuring that the child only partakes in light activities while the penis is healing
- administering pain medication as directed by the doctor
A catheter tube may be required in some cases. This will drain the urine from the bladder directly into the diaper to bypass the penis and protect the wound during healing.
Care guidelines may change depending on the patient.
When to call a doctor
Parents should contact a doctor if any of the following occurs:
- bleeding from the penis
- signs of infection, such as fever and chills
- nausea or vomiting
- loss of appetite
- difficulty urinating
- pain that is not relieved with the prescribed medication
- stitches fall out
Prompt treatment in the event of these occurrences can prevent complications.
Possible complications of chordee
Complications after surgery are rare but can occur. These may include:
- wound infections
- the need for further surgery
- allergic reaction to anesthesia
It is important for parents to discuss all possible risks with a doctor before surgery.
The outlook for infants undergoing chordee repair surgery is excellent. In most cases, the child will make a full recovery and will have a straight penis that functions normally.
If chordee is diagnosed late, surgery can be more complicated but is usually still effective. If hypospadias is present, additional work will be done to correct the curvature and extend the urethra to bring it to the tip of the penis.