Chordee

>

Chordee is a condition in which the head of the penis curves downward (that is, in a ventral direction) or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during erection, but resistance to straightening is often apparent in the flaccid state as well. In many cases but not all, chordee is associated with hypospadias. This is not the same condition as Peyronie's disease, which involves curvature of the shaft of the penis most commonly due to injury during adult life.

Presentation

It is usually considered a congenital malformation of unknown cause. Since at an early stage of fetal development the penis is curved downward, it has been proposed that chordee results from an arrest of penile development at that stage.

The curvature of a chordee can involve

1. tethering of the skin with urethra and corpora of normal size;
2. curvature induced by fibrosis and contracture of the fascial tissue (Buck's fascia or dartos) surrounding the urethra;
3. disproportionately large corpora in relation to the urethral length without other demonstrable abnormality of either; or
4. a short, fibrotic urethra that tethers the penis downward (the least common type).

Severe degrees of chordee are usually associated with hypospadias, but mild degrees of curvature may occur in many otherwise normal males. When the curved penis is small and accompanied by hypospadias, deficiency of prenatal androgen effect can be inferred.

Treatment

The principal treatment of chordee is surgery in infancy, usually by a pediatric urologist.

The preferred time for surgery is between the ages of 6 and 18 months, by which time the risk from anesthesia is low.

Correction is usually successful.

References