||This page includes images of child patients. The condition Chordee can only be illustrated with reference to a child patient.
Image © 2009 Marek Orkiszewski
What is Chordee?
Chordee is a condition in which the head of the penis curves, usually downwards. Upward curvature can occur but is very rare. In either manifestation it is usually considered to be a congenital malformation of unknown cause. Since at an early stage of foetal development the penis is curved downward, it has been proposed that the more common form of chordee, downward curvature, results from an arrest of penile development at that stage. The curvature is usually most obvious during erection, but resistance to straightening is often apparent in the flaccid state as well. Severe degrees of chordee are usually associated with hypospadias, but mild degrees of curvature may occur in otherwise normal males. The illustration on the right shows a boy with chordee and a "Monk's Hood Foreskin".
The preferred treatment of chordee is surgery in infancy, preferably by a specialist in paediatric urology. The best time for surgery is between the ages of 6 and 18 months. Earlier intervention is not advised due to the greater risks associated with general anaesthesia in younger infants. Later intervention may result in the boy having memories of the latter stages of his treatment, with adverse psychological consequences.
The goals of surgery are to improve the appearance of the penis for psychological reasons, to construct an organ that allows the patient to void urine in a standing position and to produce a sexually adequate organ. If the chordee is the result of skin tethering, the surgeon may shorten the dorsal foreskin and remove any fibrous tissue that is causing the curvature. If associated with hypospadias, chordee is corrected at the time of the hypospadias repair. Correction is usually successful.
Implications regarding circumcision
The corrective surgery will require donor tissue. Therefore it is vital that the child is not circumcised neonatally. Surgery to correct the abnormality almost certainly will (and always can) include circumcision. There may, however, be some constraints on the resulting style of circumcision that can be achieved.
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