Chordee is a condition in which the head of the
penis curves downward or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during
erection, 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 ab ...
. This is not the same condition as
Peyronie's disease, 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 c ...
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 and corpora of normal size;
# curvature induced by
fibrosis and contracture of the
fascial tissue (
Buck's fascia or
dartos) 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
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 ab ...
, 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, or from a complication of
circumcision, though some medical professionals do not consider it to be true chordee because the
corporal 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.
[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