Chordee at a glance
- Chordee is a fairly common birth defect that results in the penis bending, most notably during erection.
- Many males with chordee also have hypospadias, which is a urethral opening underneath the penis rather than at the tip.
- Most chordee is corrected easily and permanently with minor surgery during early childhood.
What is chordee?
Chordee is a birth defect in boys in which the penis is bent during an erection, which even infants can experience. Males with chordee often have hypospadias, a condition where the opening of the urethra tube through which urine passes is located on the underside of the penis rather than at the tip. Chordee is relatively common. It may occur in as many as one in 200 male births.
Children with suspected chordee or hypospadias should not be circumcised as newborns. Instead, circumcision should wait until a later date (usually about six months to one year). This is because urologists may need to use the foreskin for corrective surgeries on the penis.
Chordee may or may not cause problems with sexual function in adulthood. If chordee is not detected at a young age, it may in theory cause discomfort or pain during sexual activity, for both a man and his partner. To avoid this problem, physicians usually attempt to correct chordee during early childhood, ideally before age 2.
Chordee results from the abnormal development of the penis. Doctors are not certain what causes chordee. It is possible that it occurs when more elastic tissue grows on the upper half of the penis than on the underside, causing the erection to curve.
Symptoms of chordee
Sometimes doctors look for chordee when they observe that hypospadias is present, usually at birth or soon afterward. In some children the foreskin is misshapen. This provides a clue that chordee may be present.
Many parents of boys who have chordee without hypospadias simply observe that the penis is “bent.” Chordee, with or without hypospadias, can take several forms.
- Penile torsion (wandering raphe). In some children the midline raphe (the ridge normally found on the underside of the penis) wraps around the penis. This “wrapping” can pull the penis into a downward angle. If the torsion (or pulling) is close to 90 degrees or more, physicians may recommend surgical correction. Doctors usually make this correction during circumcision.
- Skin tethering. In some cases of skin tethering the urethra is paper-thin near the tip of the penis. Doctors may use one or more surgeries to first create a hypospadias to permit the urethra to be reconstructed, and then to repair the hypospadias. In other patients doctors use permanent sutures to straighten the penis.
- Webbed penis (penoscrotal fusion). Occasionally the underside of the penis is fused with the scrotum. During circumcision the physician will release the penis from the scrotum. Also during the procedure the physician will use the foreskin to reconstruct the underside of the penis.
- Dorsal preputial hood. This term simply means the foreskin does not cover the entire head of the penis. Instead it covers only the upper side. Often hypospadias and/or chordee go along with this condition. Physicians will evaluate for chordee or hypospadias before performing circumcision.
Treatment of chordee
Once the decision is made to surgically correct chordee, physicians evaluate the extent of chordee via an artificial erection while the child is asleep. This is performed by injecting sterile saline solution into the erectile tissues. If the degree of bending is greater than 30 degrees from a straight erection, physicians will surgically correct the curvature and circumcise the phallus, preferably before the child is age 2. If hypospadias is present, the surgeon will correct hypospadias at the same time.
If chordee is present in an older boy or an adult, the correction might require multiple surgeries (two or three).
Most chordee surgeries are outpatient procedures, meaning the patient goes home the same day.