Chordee: What you need to know

Chordee: Definition, surgery, and repair

By
Goretti Cowley   
Reviewed
by Karen Gill, MD
Chordee is a condition where
bands of tissue pull on the penis, making it appear bent or curved. This is
particularly noticeable during erection. It usually occurs in children with
hypospadias.
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.
Fast facts on chordee

  • 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 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.
Causes

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:
TypeScientific & 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

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:

  1. First, an erection test is
    carried out to assess the extent of the curvature. This involves the injection
    of saline into the penis.
  2. 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.
  3. If the penis is still bent,
    any tissue around the urethra will be removed (type 2 chordee). Again the
    erection test will be performed.
  4. 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.
  5. 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.
  6. The erection test will be
    repeated after these procedures to confirm the penis is straight.
  7. Once the penis has been
    straightened, the foreskin will be repaired, or skin will be removed to give
    the penis a circumcised look.
Recovery


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
  • scarring
  • the need for further surgery
  • allergic reaction to
    anesthesia
It is important for parents to
discuss all possible risks with a doctor before surgery.

Outlook

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.
SOURCE:
MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.