Guide for families of children with penile curvature
What is penile curvature?
Penile curvature means that the penis is curved forward, backward, or sideways. It becomes evident when the penis becomes hard. It can also be associated with a congenital anomaly called hypospadias (the urinary hole is lower than where it should be). It occurs in approximately one in 200babies.
What are the causes of penile curvature?
- Skin chordee: There is curvature in the penis only because of the abnormal fibrotic tissue (hard connective tissue) in the penile skin.
- Fibrotic fascia: Curvature occurs in the subcutaneous tissues of the penis, called fascia, due to abnormal fibrotic tissues.
- Corporal incompatibility: It develops when the cylindrical structures that provide the erection (hardness) of the penis cannot develop in harmony with each other. In the anatomical structure of the penis, there are two spongy tissues containing blood vessels that provide erection, and a spongy tissue (urethra) in which the urinary tract is located. In the intrauterine period, growth retardation may occur in one of these spongy structures. This situation causes the penis to curve towards the side where the development is less during erection.
- Shortness of the urinary canal (urethra): The shortness of the urinary canal also causes the inconsistent development of the cylinders responsible for erection in the penis and bending forward. In hypospadias patients, the development of the urethra is less and the penis curves downward during erection.
How is it diagnosed?
The curvature is usually noticed during urinating when the penis becomes erect. This may not be very noticeable during infancy. However, when the child starts to hold his urine, it is recognized by noticing that he urinates crookedly or urinates towards his feet, especially when urinating standing up, and cannot urinate directly across.
Photographs taken by the family during the erection of the child help the physician to diagnose and decide on the surgical treatment. Penile curvature can be seen in every man up to 20 degrees down, up, right, and left. Penile curvatures up to 20 degrees are considered normal as they do not impair sexual function and do not require treatment. An angle of curvature greater than 30 degrees is considered clinically significant and surgical treatment is recommended.
How is the surgery performed?
The surgery is performed in the operating room and under general anesthesia. The first thing to do during the surgery is to make circumcision to separate the penile skin from the foreskin. Then the skin is released up to the root of the penis. In this way, a possible skin chordee is also treated. Afterwards, an artificial erection is performed to determine the exact angle of the penile curvature. In this way, the actual degree and severity of the penile curvature are determined. Fibrotic tissues in the fascia that may cause penile curvature are observed and removed if present. Sometimes removing these abnormal tissues can also correct the curvature.
If the penile curvature does not improve despite everything, then other surgical techniques are decided. The surgeon's experience is as important as the degree of curvature in the selection of these techniques. The technique called penile plication is especially preferred in cases where the curvature of the penis is not too great, and the penis will not shorten after the application. In this technique, the point where the curvature is highest is determined and the curvature of the penis is corrected with non-melting sutures on the opposite side of this point. It is necessary that these sutures do not disturb the symmetry of the penis, do not shorten the penis excessively, and should be placed away from nerves and vessels.
Another method is to patch the curved part with tissue from another part of the body (usually a vein or skin). This technique is preferred in cases where the curvature of the penis is more. In this technique, the curved area of the penis is cut transversely, and a vein or skin patch is placed in this area. In cases where the curvature of the penis is much greater, plication on the healthy side and patching on the curved side may also be required. If the cause of the penile curvature is determined to be corporal incompatibility during the surgery, then all the structures that make up the penis are separated from each other. This is a much more aggressive and difficult technique. The two cylinders, the urethra and the vascular-nerve bundle of the penis are separated, and the rotation of the cylinders can be corrected. Sometimes, plication can also be applied at this tim
Can penile curvature recur after surgery?
Recurrence of penile curvature after surgery is very rare, especially in children, but it may require a second surgery depending on the degree of curvature.