Chordee is a condition in which the head of the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

curves downward or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during

erection An erection (clinically: penile erection or penile tumescence) is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, ...

, but resistance to straightening is often apparent in the flaccid state as well. In many cases but not all, chordee is associated with

hypospadias Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location in the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting abou ...

. This is not the same condition as

Peyronie's disease Peyronie's disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, ca ...

, which involves curvature of the shaft of the penis most commonly due to injury during adult life.

Signs and symptoms

It is usually considered a

congenital malformation A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can r ...

of unknown cause. Since at an early stage of fetal development the penis is curved downward, it has been proposed that chordee results from an arrest of penile development at that stage. The curvature of a chordee can involve # tethering of the skin with

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

and corpora of normal size; # curvature induced by

fibrosis Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perma ...

and contracture of the

fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs. ...

l tissue (

Buck's fascia Buck's fascia (deep fascia of the penis, Gallaudet's fascia or fascia of the penis) is a layer of deep fascia covering the three erectile bodies of the penis. Structure Buck's fascia is continuous with the external spermatic fascia in the scrotu ...

dartos The dartos fascia or simply dartos is a layer of connective tissue found in the penile shaft, foreskin, scrotum and labia. The penile portion is referred to as the superficial fascia of penis or the subcutaneous tissue of penis, while the scrotal ...

) surrounding the urethra; # disproportionately large corpora in relation to the urethral length without other demonstrable abnormality of either; or # a short, fibrotic urethra that tethers the penis downward (the least common type). Severe degrees of chordee are usually associated with

, but mild degrees of curvature may occur in many otherwise normal males. When the curved penis is small and accompanied by hypospadias, deficiency of prenatal androgen effect can be inferred.

Cause

A chordee may be caused by an underlying condition, such as a

disorder of sex development Disorders of sex development (DSDs), also known as differences in sex development, diverse sex development and variations in sex characteristics (VSC), are congenital conditions affecting the reproductive system, in which development of chromos ...

or an

intersex condition Intersex people are individuals born with any of several Sexual characteristics, sex characteristics including chromosome patterns, gonads, or sex organ, genitals that, according to the Office of the United Nations High Commissioner for Hum ...

, or from a complication of

circumcision Circumcision is a surgical procedure, procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin ...

, though some medical professionals do not consider it to be true chordee because the

corporal Corporal is a military rank in use in some form by many militaries and by some police forces or other uniformed organizations. The word is derived from the medieval Italian phrase ("head of a body"). The rank is usually the lowest ranking non ...

bodies are normally formed. However, not all congenital chordee includes abnormal corpora, and case reports of damage to the corpus cavernosum from circumcision are noted in the literature; particularly as a complication of local anesthetic.

Treatment

The principal treatment of chordee is surgery in infancy, usually by a

pediatric urologist Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are ...

. With chordees caused by circumcision, the preferred method of surgical treatment is a

z-plasty Z-plasty is a versatile plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central ele ...

.Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-9. The preferred time for surgery is between the ages of 6 and 18 months and correction is usually successful.

References

External links

{{Male congenital malformations of genital organs, indeterminate sex and pseudohermaphroditism Congenital disorders of male genital organs Penis disorders