A variation of hypospadias occurs when the urinary opening is in the correct location in the head of the penis, but there is only a partial foreskin. This is called “chordee without hypospadias” because the head of the penis often appears bent downwards. “Chordee” is simply another word for “curvature”.
In other boys, the foreskin is normal, but the penis is bent, usually down towards the feet. Occasionally, bending can occur to one side (almost always the left side, called lateral curvature), or even backwards towards the belly, called dorsal curvature. Penile curvature is a common problem in children, but the underlying cause is not known.
Surgery is often recommended to release tethering of the skin and repair the bend in the penis. At the same time, the skin can be managed either with circumcision, or with repair of the foreskin, depending on the wishes of the caregivers. If the circumcision was postponed due to the curvature but the family desires one, we recommend fixing the curvature and performing the circumcision at the same time to minimize discomfort. This can be done safely anytime after the age of 3 months in healthy, term infants with a minor procedure called a phalloplasty.
Penile curvature can cause discomfort during intercourse – for the patient, for the partner, or both – depending on the degree and the direction of the bend. Penile birth defects like curvature and foreskin abnormalities may also be a source of locker-room embarrassment. Repair for boys and men with less than 30 degrees of curvature is nearly always successful in a single surgery. Sometimes hypospadias – an abnormal position of the urinary channel – is discovered at surgery, and can be repaired at the same time. The goals of repair are to restore normal function and cosmesis.
Much less common is severe penile curvature, defined as more than 30 degrees. Evidence has shown a common way of correcting curvature, using stitches opposite the bend called plications, has a higher rate of failure when there is more than 30 degrees of bend. This curvature is more successfully repaired by lengthening the short side instead of shortening the long side with plication stitches. When the short side is lengthened, a graft may be needed to fill in the space. Where the graft comes from and whether repair can take place in one surgery or a planned two-stage approach depends on the particular anatomy – for instance if a shortened urinary channel is acting as a bow string, causing the severe bending, but can often be anticipated by a surgeon experienced with grafts.
Examples of chordee without hypospadias (A,B) and lateral penile curvature (C,D). Dorsal (backwards) curvature is seen before (E) and after (F) correction with a phalloplasty in a post-pubertal patient.