Chordee is a condition in which the penile shaft is bent downward, resulting from abnormal development of penis in the womb. It is more prominent during erection, but can also be noticed in a flaccid state. Sometimes, it is associated with hypospadias(ureteral opening beneath the penis instead of at the tip)
In mild cases, it is usually undiagnosed till puberty.
CAUSES
The exact mechanism is difficult to define, it usually results from arrest of penile growth at an early developmental stage. The reason can be an imbalance of elastic tissue development between the top and bottom side of penis. It can also be due to the tethered skin or abnormal scar tissue on the underside of penis or around the urethra. This can also be a complication of circumcision.
SYMPTOMS
A curved penis is the most visible symptom of chordee. If accompanied by hypospadias, urinary problems such as double stream, urine splash etc can occur. Chordee can also be associated with Penile torsion, dorsal preputial hood, skin tethering and webbed penis. Sex can be uncomfortable, difficult or impossible for some men.
DIAGNOSIS
Physical examinations usually confirm the diagnosis. A saline artificial erection test can be used to confirm the diagnosis, by making penis firm and demonstrating the curvature.
TREATMENT
Treatment is surgical.
There are Several techniques depending upon the cause and severity, with the aim to make penis straight by equalising length of the shorter and longer side. The surgery may involve;

• Removal of tissue casing the curvature, to make the penis straight
• Lengthening of urethra in case if it is short, by utilizing adjacent skin
• Correction of hypospadias

All cuts are closed with dissolvable sutures.
Sometimes, a tube can be placed for drainage of urine, which is usually removed after one week.
Artificial erection with saline is performed to make sure that penis is straight.
Sterile surgical dressing is applied.
FAQs
1. Are there any alternatives to an operation?
No, the only effective treatment is surgery. The ideal time for chordee repair is around 2 years of age.
2. How Long Will the procedure Take?
Operation takes about 1-2 hours—longer if there are other associated problem
3. Does it need admission?
The chordee correction is done in an outpatient setting. Patients can go home the same day. It is usually performed under general anaesthesia. Fasting is needed before surgery.
4. Is it painful?
No, the procedure is performed under anesthesia and after surgery pain relief medications are given.
5. Is chordee repair successful?
It is generally a very successful procedure in childhood. Though surgery is still an effective treatment in adults, some patients may need additional procedures for complete correction.
6. What are the complications?
bleeding and infection, wound breakdown, bladder spasm(if urinary catheter is placed), recurrence of chordee.
7. How is the recovery period ?
Soon after surgery, the child will be able to eat and drink after recovery from anesthesia. There might be some discomfort in the initial couple of days. Your child will be uncomfortable for a few days. You can pick them up, cuddle them and treat them normally from immediately post operatively. The dressing and drainage tube will be removed after one week, till then they should be kept dry. Baths and showers should be avoided until after everything is removed.

 

Written by : Dr. Sobia Yasmeen
Copyrights: Pakistan association of Plastic Surgeons