What is Chordee?
Chordee happens when the penis curves sharply up or down. It usually happens at the very end of the penis at the glans, or tip.
Chordee is relatively common, happening in about 1 of every 200 births of male children. It’s a congenital condition, meaning that your child can be born with it. If this is the case, your doctor will likely diagnose it right away and talk to you about possible surgery for your child.
Chordee with hypospadias
Chordee can occur with hypospadias. Hypospadias is a condition in which the urethral opening is located on the underside of the penis rather than at the tip. The opening can be located in one of several possible places:
. Right under the tip of the penis (distal)
. Along the bottom of the penis shaft (midshaft)
. Where the penis is attached to the scrotum, the sac of skin that holds the testicles (penoscrotal)
. On the perineum, the area of skin between the scrotum and anus (perineal)
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Before Chordee Treatment
Symptoms
What are the symptoms of chordee?
The most visible symptom of chordee is a sharp curve of the penis, either upward or downward. This curve can start anywhere from the base of the penis near the testicles to the beginning of the glans.
If you also have hypospadias, your urine may splash or go in an unintended direction when you urinate. This symptom doesn’t occur in all cases, however.
Other possible symptoms of chordee include:
. Penile torsion. The midline raphe, located on the bottom of the penis shaft, circles around the penis tissue rather than running along the shaft.
. Dorsal preputial hood. The foreskin — the tissue that usually wraps around the tip of the penis — only covers the top half of the penis.
. Skin tethering. The tissue around the urethra near the tip of the penis is extremely thin.
. Webbed penis. The skin on the bottom of the penis shaft is connected to the skin of the scrotum, creating an area of webbed skin.
In some men, sex can be uncomfortable, difficult, or impossible because of the shape of the penis.
In mild cases of chordee, a person may not notice that his penis is curved until he gets his first erection during puberty.
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What causes chordee?
Chordee can happen when the penis suddenly stops growing while a fetus is developing during pregnancy for one of several reasons. Research suggests that the tissues that eventually become the penis are normally curved around the 10th week of pregnancy. If the child is born with a curved penis, this means that the tissues may have stopped developing around that time and remained curved.
Doctors aren’t sure what causes tissues to stop growing. Genetics may be part of the reason. Circumcision done while a child’s penis is inflamed can also cause chordee. This is because thick, healing scar tissue can pull the penis up or down, causing it to curve.
How is chordee diagnosed?
Because chordee is congenital, your doctor may be able to diagnose chordee by looking for symptoms on the penis when your child is born. Other diagnostic tests include:
. Using a saline solution to make your child’s penis firm to see how much their penis curves. If it curves 30° up or down, your doctor will recommend surgery for chordee.
. Urine and blood tests to check your child’s overall health.
Your doctor may refer you to a pediatric urologist to confirm the diagnosis and perform any necessary surgery.
Possible complications of chordee
Complications after surgery are rare but can occur. These may include:
. Wound infections
. Scarring
. The need for further surgery
. Allergic reaction to anesthesia
It is important for parents to discuss all possible risks with a doctor before surgery.
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During Chordee Treatment
How is chordee treated?
Your doctor will discuss the benefits and risks before the surgery and whether your child needs to stop taking any medications.
Your doctor can treat chordee by straightening your child’s penis and making sure that the urethral opening is at the tip of the penis. To do this, your surgeon will:
- Use anesthesia to make sure your child stays asleep during the surgery.
- Take away any extra tissue that’s causing the penis to bend.
- Use the tissue to make the penis straight and make sure it’s the same length on all sides.
- Extend the urethra to the tip of the penis where the tissue has been operated on.
- Stitch any openings or cuts closed.
- Fill the penis with a saline solution to check how straight the penis is after surgery.
- Wrap the penis in a surgical dressing to keep it straight and protected.
To treat hypospadias, your surgeon will also:
- Move the urethra to the area of new penis tissue.
- Close the hole where the urethral opening was before.
- Create a new hole for urine to pass through.
- Stitch any openings and cuts closed.
Your surgeon may use a plastic surgery technique called Z-plasty to treat any scars that may have caused chordee after circumcision.
After Chordee Treatment
Recovery
When the infant returns home after surgery, parents are required to follow care guidelines provided by the doctors such as:
. Following a liquid diet for at least 1 day after surgery
. Keeping the bandage and surrounding areas clean
. Giving the child sponge baths only for the first 7 days, ensuring that the penis stays dry.
. Giving the child short baths or showers regularly 1 week after surgery, especially after bowel movements.
. Making sure to thoroughly dry the child after bathing and using a blow dryer on the cool setting to help to dry the penis.
. Using double diapers on the child for added protection, and changing frequently
. Ensuring that the child only partakes in light activities while the penis is healing
. Administering pain medication as directed by the doctor
. Use prescription ointments to prevent irritation or rashes.
A catheter tube may be required in some cases. This will drain the urine from the bladder directly into the diaper to bypass the penis and protect the wound during healing.
Some swelling is normal.
The chances of success are much higher if the surgery is done between the ages of 4 and 6 months. Chordee surgery can be more complex if put off until adulthood.
If you’re an adult having this procedure, avoid physical activity, including sex, until your doctor says you can resume, usually about four to eight weeks after the surgery.
Care guidelines may change depending on the patient.
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When to call a doctor
Parents should contact a doctor if any of the following occurs:
. Bleeding from the penis
. Signs of infection, such as fever and chills
. Nausea or vomiting
. Loss of appetite
. Pain that is not relieved with the prescribed medication
. Stitches fall out
. Swelling, or redness where the surgery was done
. High fever of 101°F (38°C) or higher
. Having trouble urinating or not being able to urinate at all
. Urine leaking out of the urethra (fistula)
Prompt treatment in the event of these occurrences can prevent complications.
Outlook
The outlook for infants undergoing chordee repair surgery is excellent. In most cases, the child will make a full recovery and will have a straight penis that functions normally.
If chordee is diagnosed late, surgery can be more complicated but is usually still effective. If hypospadias is present, additional work will be done to correct the curvature and extend the urethra to bring it to the tip of the penis.
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