Penile Torsion



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Last updated: 01 March 2014, 16:11 UTC



What is Penile Torsion and what causes it?

Penile Torsion is a rotation of the shaft of the penis, usually to the left (counter-clockwise) direction. It results in the urethral meatus being placed in an oblique position, such that the median raphe makes a spiral curve from the base of the penis to the meatus. In some cases, penile torsion is associated with mild forms of hypospadias or hooded prepuce.

It is a congenital defect sometimes attributed to the improper extension of the 'Dartos' tissue of the scrotum into the penile shaft. (Dartos tissue is normally found only in the scrotum and is the tissue responsible for reacting to temperature change, contracting when cold and stretching when warm so as to regulate the temperature of the testes.)


Uncorrected penile torsion (8221 Bytes) Corrected penile torsion (8332 Bytes)
Before correction
After correction
Infant with penile torsion (137037 Bytes) Adult with penile torsion (39081 Bytes)
Child patient
Comparable adult patient
All images © 2006 Kaohsiung Chang Gung Memorial Hospital, Taiwan


Treatment

In the past, physicians did not recommend operative correction because they believed that attempts to move the skin would not correct spiral mis-alignment of the corpora cavernosa, the erectile tissue.

Modern thinking differs. In some cases, resection of the Buck's Fascia is needed to provide correction, a procedure now well within the limits of surgical norms in a hospital specialising in paediatric urology. Careful alignment of the skin during closure gives an excellent cosmetic result. The ease of achieving a normal appearance seems to justify surgical correction, especially given the risk of painful or dysfunctional erections in later life if the condition remains uncorrected.

Surgery is best performed between 6 and 18 months of age. Any younger carries increased risks from the required general anaesthetic. Any older and there is the risk of psychological problems resulting from the boy having some memory of his treatment.


Implications regarding circumcision

The corrective surgery may require donor tissue. Therefore it is important 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.


Acknowledgements

The following resources were used in the preparation of this web page:
Taiwan flag Kaohsiung City logo (5780 bytes) Kaohsiung Children's Hospital logo (21955 bytes) The website of Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
<peds.com.tw>. (Traditional Chinese text)

Italian flag (512 bytes) Medscape Logo (5542 bytes) Medscape article number 1016681 by Luigi Avolio, MD.  (English text)

USA flag (1336 bytes) Stanford School of Medicine logo (2730 bytes) Website of Stanford School of Medicine.




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