- What is chordee?
Chordee is a condition where there is an abnormal curvature of the penis which can be downwards, upwards or sideways. When its downward it is called ventral chordee and when its sideway it’s called lateral chordee. It can occur with or without hypospadias.
Rarely the penis may bend upwards also which is called as dorsal chordee.
- What is the incidence of chordee without hypospadias and why does it occur?
Chordee without hypospadias is often missed on diagnosis but occurs at a rate of almost 10% as the incidence of hypospadias itself, which means 1 out of almost 1500 or 2000 boys.
Ventral chordee occurs due unequal tissues on upper and underside of penis. This shortage may be at level of skin, tissues under the skin, or even tunica albuginea or urethra.
- Short skin: This is often visible as a penoscrotal web or tight skin on underside and is the most common cause of chordee
- Fibrotic bands under skin: Sometimes the elastic tissue under penile skin may be tight or have bands which cause ventral bending of penis.
- Tunica albuginea shortage: The tunica albuginea is the tough, elastic tissue that surrounds the two erectile chambers of the penis. If more of this tissue develops on the top of the penis than on the underside, it can cause the penis to curve downward during an erection.
- Congenital short urethra: During an erection, the erectile chambers in the penis expand with blood. The urethra, which normally allows urine to pass, needs to be flexible enough to accommodate this expansion without kinking or pulling. When the urethra is congenitally short, it may not have enough slack or flexibility. As the penis expands during an erection, the short urethra pulls downward, causing the penis to bend.
- Corporeal disproportion: The penis consists of two main erectile chambers called the corpora cavernosa. In some cases of chordee, these chambers may develop unevenly. This can mean one corpus cavernosum is longer than the other and has a different shape or structure. This uneven development creates a tug-of-war effect during erection, causing the penis to bend towards the side with the shorter or structurally different corpus cavernosum.
- What are the symptoms of chordee without hypospadias?
Symptoms of chordee without hypospadias include:
- A downward or sideways bend in the penis during an erection
- Urine may deflect to one side in case of lateral chordee
- In an adult the presence of chordee may cause difficulty in performing intercourse or painful erection.
- What are the treatment options for chordee without hypospadias?
Treatment for chordee without hypospadias depends on the severity of the chordee.
Ventral chordee correction:
If the chordee is mild (10-15 degree), no surgery may be required. It is important that such children are followed up at 14-15 years of age to check that chordee is not worsening after puberty.
If the chordee is between 15–30-degree, surgery is often required to correct the chordee. During the surgery, deep degloving is done before assessing the chordee in the intra operative period. If chordee is less than 30 degrees after degloving, then chordee correction can be done by placing a stitch on the top side of the penis at 12’o clock position which is called dorsal tunical albuginea plication, which will correct the chordee completely.
If the chordee is more than 30 degrees after degloving, two stage repair will be required for chordee correction. In the first stage, chordee is completely corrected but the urethral opening will recede. In the second stage the urethral opening is brought to the tip of the penis.
Correction of lateral chordee:
Degloving is the first step in any type of chordee. Tunica albuginea plication is done on the convex side at the site of maximum curvature. Lateral chordee when not associated with hypospadias can be corrected in single stage.
Dorsal Chordee correction:
Dorsal chordee is corrected by ventral tunical plication next to the urethra on either side.
If you are concerned that you or your child may have chordee, it is important to see a doctor to get a diagnosis and discuss treatment options.
About Hypospadias Foundation
Hypospadias foundation is dedicated to care of children and adults suffering from Hypospadias. Since Nov 2008, more than 5000 children and adults have been treated for hypospadias at Navi Mumbai India. We treat more than 250 cases every year and these cases come from all over India and more than 25 countries who come to Navi Mumbai for state of art treatment, hypospadias surgery and excellent post operative outcomes. We at hypospadias foundation manage all types of hypospadias which includes even the most complex ones after multiple failed repairs. We strive to achieve excellence in this field of hypospadias with our excellent outcome.