Congenital penile curvature (CPC) or chordee is a congenital anomaly that may present as an independent entity or be associated with hypospadias. CPC manifests as a curvature of the penis when in its erect state.1 The cause of chordee remains unknown, but there are speculations that it is the result of excessive elasticity of one side of the penis compared with the other.2 Penile curvature associated with hypospadias is mainly ventral and is caused by tethering of the skin, fibrosis, contracture of the fascial tissue surrounding the urethra, and a disproportionately large corpora or a short urethral plate. Penile curvature of >20° is considered significant and surgical repair is the only viable treatment option.3 Successful correction of the ventral penile curvature requires mobilisation of the neurovascular bundle and dorsal plication of the tunica albuginea.4–6
We evaluated 172 patients aged 14–18 years, treated for CPC between January 2002 and December 2006. There were 98 patients with ventral penile curvature associated with hypospadias and 74 with isolated CPC. Correction of CPC was performed under pharmacological erection, induced by prostaglandin E1, to determine the exact point of maximal curvature and to check the result of penile straightening. After cautious mobilisation of the penile neurovascular bundle, curvature correction was performed by dorsal plication corporoplasty using polydioxanone sutures.
In our group of patients the mean follow-up was 10.8 years. All patients were tested for penile length, presence of curvature, quality of erection, and sensitivity of the glans. Length of the erect penis ranged from 7.2–12.8 cm. Residual ventral curvature was noted in four patients who were initially treated for CPC with hypospadias (4%). One case of recurvature and one of lateral curvature were diagnosed in the second group of 74 patients (2.7%). All patients reported good quality of erection and preserved sensitivity of the glans.
Hypospadias is one of the most common congenital anomalies, with an increasing trend. It can be associated with ventral penile curvature in both severe and distal forms.3 Independent CPC is also very common among male live births, and thus represents a challenge to classify and correct in particular.7 The repair of curvature is necessary as CPC can cause potential sexual dysfunction, difficulty, and pain during intercourse, or complete coital incapacity, and if untreated can lead to severe psychological problems.2,8 Dorsal plication of the tunica albuginea presents a safe and simple method for CPC repair.5,7 Our data confirm that satisfactory length of the penis and preserved sensation and erection are present with a low rate of recurrence at long-term follow-up.