Chordee release is a surgical procedure designed to correct a congenital curvature of the penis. This condition, present from birth, causes a bend or downward curve, which can become more pronounced during an erection. The goal of the surgery is to straighten the penis, addressing the underlying anatomical issues that contribute to the curvature.
What is Chordee?
Chordee is a congenital condition, characterized by a downward curvature of the penis. While the exact cause is not fully understood, it often results from abnormal development of penile tissues during fetal growth. The prevalence of chordee has been reported at approximately 8.6% of male newborns in the United States.
There are several forms of chordee, each contributing to the curvature in different ways. Skin chordee involves an irregular growth of tissue under the penis that pulls it downward toward the scrotum. Fibrous chordee occurs when irregular tissue growth on the penile shaft around the urethra causes the penis to bend, sometimes downward, laterally, or even backward. Another type is corporeal disproportion, where the erectile chambers (corpora cavernosa) are of unequal length, leading to a bend. Finally, a short urethra can also cause chordee, where the urinary tube is short and tethers the penis downward.
Why Chordee Requires Correction
Correction of chordee is often recommended due to its potential impact on both function and quality of life. In some cases, an uncorrected penile curvature can lead to difficulties with urination, particularly if the curvature is severe or associated with hypospadias, a condition where the urethral opening is not at the tip of the penis. This can result in urine spraying, requiring individuals to sit to urinate.
Beyond urination, uncorrected chordee can significantly affect sexual function later in life. The curvature can make sexual intercourse difficult or even painful for both the individual and their partner. This can lead to dissatisfaction with sexual activity and may prevent sexual interaction. The cosmetic appearance of an uncorrected curvature can lead to body image concerns, self-consciousness, and lower self-esteem, which can persist into adulthood.
The Chordee Release Procedure
The procedure typically begins with a circumcising incision and reflection of the skin to expose the penile shaft. An artificial erection test is then performed by injecting saline into the penis to accurately assess the extent and direction of the curvature.
The specific surgical technique employed depends on the identified type of chordee.
Skin Chordee
For skin chordee, the surgeon releases the tethering skin and any inelastic tissue.
Fibrous Chordee
If fibrous bands are present, these tissues are carefully excised.
Corporeal Disproportion
In cases of corporeal disproportion, where the erectile bodies are unequal in length, techniques such as plication sutures are used to shorten the longer side of the penis, or incisions may be made in the shorter side, with the gap then patched with a graft.
Short Urethra
If the curvature is due to a short urethra, the urethra may be lengthened using tissue from the foreskin or another site.
The artificial erection test is repeated throughout the procedure to confirm the penis has been straightened. This procedure is often performed as an outpatient surgery, lasting approximately one to three hours.
Recovery and Outcomes
Following chordee release surgery, patients can expect a recovery period involving specific care instructions to promote healing. Pain management is addressed with prescribed medications. Wound care involves keeping the surgical site clean and dry. If a urinary catheter or stent was placed to aid urine drainage, instructions for its care and removal are provided.
During initial recovery, activities are restricted to light movements, and straddle toys or activities requiring balance are avoided to prevent strain on the healing area. Swelling, redness, and bruising of the penis are common and expected to subside over time. Most children make a full recovery, with the penis achieving a straight and functional appearance. The overall success rate for chordee correction is high. Follow-up appointments are scheduled to monitor healing and confirm the long-term success of the procedure.