Chordee is a condition in which the

head A head is the part of an organism which usually includes the ears, brain, forehead, cheeks, chin, eyes, nose, and mouth, each of which aid in various sensory functions such as sight, hearing, smell, and taste. Some very simple ani ...

of the

penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...

curves downward or upward, at the junction of the head and shaft of the penis. The curvature is usually most obvious during

erection An erection (clinically: penile erection or penile tumescence) is a Physiology, physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, ...

, but resistance to straightening is often apparent in the

flaccid Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e.g., trauma). This abnormal condition may be caused by disease or by trauma affecting the nerves assoc ...

state as well. In many cases but not all, chordee is associated with

hypospadias Hypospadias is a common malformation in fetal development of the penis in which the urethra does not open from its usual location on the head of the penis. It is the second-most common birth defect of the male reproductive system, affecting about ...

. This is not the same condition as

Peyronie's disease Peyronie's disease (PD) is a benign, acquired penile connective tissue disease characterized by the occurrence of fibrotic plaques within the Tunica albuginea (penis), tunica albuginea — the dense elastic covering of the Corpora cavernosa of pe ...

, which involves curvature of the shaft of the penis most commonly due to injury during adult life.

Signs and symptoms

It is usually considered a

congenital malformation A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...

of unknown cause. Since at an early stage of fetal development the penis is curved downward, it has been proposed that chordee results from an arrest of penile development at that stage. The curvature of a chordee can involve # tethering of the skin with

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

and corpora of normal size; # curvature induced by

fibrosis Fibrosis, also known as fibrotic scarring, is the development of fibrous connective tissue in response to an injury. Fibrosis can be a normal connective tissue deposition or excessive tissue deposition caused by a disease. Repeated injuries, ch ...

and contracture of the

fascia A fascia (; : fasciae or fascias; adjective fascial; ) is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, visceral or deep, and further designated according to their anatomical location. ...

l tissue (

Buck's fascia Buck's fascia (deep fascia of the penis, Gallaudet's fascia or fascia of the penis) is a layer of deep fascia covering the three erectile bodies of the penis. Structure Buck's fascia is continuous with the external spermatic fascia in the scro ...

or dartos) surrounding the urethra; # disproportionately large corpora in relation to the urethral length without other demonstrable abnormality of either; or # a short, fibrotic urethra that tethers the penis downward (the least common type). Severe degrees of chordee are usually associated with

, but mild degrees of curvature may occur in many otherwise normal males. When the curved penis is small and accompanied by hypospadias, deficiency of prenatal androgen effect can be inferred.

Cause

A chordee may be caused by an underlying condition, such as a

disorder of sex development Disorders of sex development (DSDs), also known as differences in sex development, variations in sex characteristics (VSC), sexual anomalies, or sexual abnormalities, are Congenital disorder, congenital conditions affecting the Human reproductive ...

or an intersex condition, or from a complication of

circumcision Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. T ...

, though some medical professionals do not consider it to be true chordee because the

corporal Corporal is a military rank in use by the armed forces of many countries. It is also a police rank in some police services. The rank is usually the lowest ranking non-commissioned officer. In some militaries, the rank of corporal nominally corr ...

bodies are normally formed. However, not all congenital chordee includes abnormal corpora, and case reports of damage to the corpus cavernosum from circumcision are noted in the literature; particularly as a complication of local anesthetic.

Treatment

The principal treatment of chordee is surgery in infancy, usually by a

pediatric urologist Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are ...

. With chordees caused by circumcision, the preferred method of surgical treatment is a

z-plasty Z-plasty is a versatile plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central el ...

.Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-9. The preferred time for surgery is between the ages of 6 and 18 months and correction is usually successful.

References

External links

{{Male congenital malformations of genital organs, indeterminate sex and pseudohermaphroditism Congenital disorders of male genital organs Penis disorders