Chordee is a birth defect found in children where the penis stays bend particularly during erection. ‘Chordee’ is another word for curvature. It is a relatively common condition occurring in 1 in 200 male births. Chordee is found along with hypospadias, a condition in which the urethral opening is gone underside of the penis instead of being at the tip. A male child with chordee and hypospadias should not undergo circumcision as the foreskin might be required by uro-surgeons to perform corrective surgeries. It is advised to get circumcised after 6 months to 1 year of age.
Chordee should be corrected during the early childhood, ideally before the age of 2. If not detected and treated at the young age, it may cause pain or discomfort during sexual activity to both the partners.
The cause of chordee is not known by the doctors. However, the theory says that sometimes the growth of elastic tissues is more on the upper side of the penis than the underside causing the unwanted curvature.
Generally, parents can observe a ‘bent’ in the penis and report to the doctor for treatment. During birth or soon afterward, if hypospadias is present, doctors always check for chordee. Also if they observe deformed foreskin, they check for signs of chordee.
There are 4 key forms of chordee, with or without hypospadias
Penile torsion (wandering raphe) – The midline raphe (the ridge normally found on the underside of the penis) wraps around the penis pulling it at a downward angle. If this torsion (or pulling) is close to 90 degrees or more, doctors recommend surgical correction that is usually performed during circumcision.
Skin tethering – In some children, the skin tethering the urethra is found to be paper-thin at the tip of the penis. In such cases, the doctor uses one or more surgeries to permit urethra reconstruction and then repair hypospadias. In other cases, surgeons might directly use permanent sutures to straighten the penis.
Webbed penis (penoscrotal fusion) – In this type, the penis is found webbed with the scrotum on the underside. In such cases, the surgeon separates the scrotum from the penis during circumcision and use the foreskin to reconstruct the underside of the penis.
Dorsal preputial hood –In this case, the foreskin is found only on the upper side of the penis. It does not cover the head of the penis. This is found in most cases of hypospadias and/or chordee.
Diagnosis is relatively simple and made by:
Most of the cases are detected within the first few months of the child’s life. Corrective treatments and surgeries are typically scheduled when the child becomes 6-18 months old. Sometimes, chordee is not detected till the child hits puberty and the curvature gets more apparent during an erection. However, surgery can still be performed but with increased chances of complications. Early intervention of treating chordee is preferred to prevent the development of insecurities or a negative body image later in life.
The chordee corrective surgery is carried out by a pediatric urologist who is an expert in this area. It lasts generally from 1-3 hours and the child/person can be taken home the same day. It consists of injecting saline into the penis multiple times and constantly checking erections till the penis is straight. Any excess skin is removed during the act. (It is called degloving). The surgeon also checks and removes excess tissue around the urethra and corrects any physical abnormalities found. The erection test will be repeated and once the penis is straight, the foreskin will be repaired or removed based on individual conditions.
Parents have to take utmost care of the child post the surgery. The child has to be on a liquid diet for at least one-day post-surgery and ensure to keep the bandage and the surrounding areas near the penis clean and dry. Be careful during child bathing. Initially, it is advised to give the child only sponge bath for first 7 days. After that, short baths or showers can be given regularly ensuring that penis stays dry, also during bowel movements. Parents can use double diapers for added protection and must be changed frequently. Pain medication must be applied as prescribed by the doctor. Engage the child only in light, physical activities while the penis is healing.
An insertion of catheter can be an easier option in some cases which can help drain the urine from the bladder directly onto the diaper, bypassing the penis and protecting the wound during healing.
Chordee is a very common occurrence but early detection during early childhood is important. The infant usually has a smooth recovery from such corrective surgery and can have a fully functional, straight and normal penis in few days. However, an older adult might require more than one surgeries to correct the condition.
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