V.C., a 2-year male child was brought to Hypospadias Foundation with complaints of abnormal urine opening and urine stream deviated to the left. On examination, the urethral opening was noted just below the head of penis (coronal sulcus) with deficient prepucial skin on the underside of penis- distal penile hypospadias. Also, we noted that the child had a rotated penis- by almost 90 degrees to the left side- this is called penile torsion and hence urine stream if directed to that side. So, the final diagnosis was distal penile hypospadias with penile torsion.
Clinical picture showing penile torsion (penis rotated to left side)
Clinical picture showing distal penile hypospadias
V.C. was planned for single stage surgery which was penile torsion correction along with urethroplasty for hypospadias repair. A stay stitch was taken on the penis, incisions were marked and complete degloving of penis was done. Degloving the penis with division of bands under the skin alone corrected the penile torsion completely.
Incisions marked at the start of hypospadias surgery
After complete degloving, there is no torsion
Then we proceeded to check chordee (downward bending of penis). Chordee assessment showed presence of chordee of 20- 30 degree. Tunica plication was done at 12’o clock on the upper part of penis opposite to the site of maximum bend and chordee was corrected. Repeat chordee test showed no chordee.
Clinical picture showing chordee
Clinical picture showing no residual chordee after chordee correction
Following torsion and chordee correction, we raised a flap from the dartos tissue of the prepuce for second layer coverage of the urethra. We also gave an incision on the glans to raise the glans wings. A small TIP incision was given in the urethral plate as a step towards TIP or Snodgrass urethroplasty.
Dartos flap raised from prepuce for second layer coverage
Glans wings raised for urethroplasty
Shallow TIP incision in the urethral plate
Clinical picture showing urethroplasty
Clinical picture showing dartos second layer and Glansplasty finished.
The urethroplasty was done with absorbable sutures over a 7Fr urinary catheter and new urethral opening was created at the tip of glans.
After completion of urethroplasty, the penile shaft skin was rotated adequately to correct the penile torsion. At the end of the surgery the penile torsion was completely corrected.
Completed urethroplasty and corrected penile torsion
We removed the hypospadias dressing on post-operative day 7 and hypospadias catheter removed on POD10. Child passed urine well in straight stream (no deviation of urine stream). The hypospadias surgery site healed well with no complications. At 3 months check-up after hypospadias surgery, the child is doing very well without any issues. The parents were very happy with the results of the hypospadias repair surgery and correction of penile torsion in one stage.
Well healed penis at end of three months- no torsion
Good outcome at 3 months
Facts about penile torsion
- Penile torsion is a common congenital condition seen in male infants in which the penis is rotated or twisted on its axis either to the left or right side
- Children are brought with complaints of deviation of stream to the side of torsion.
- Penile torsion is found to be commonly associated with hypospadias
- Minor degree of penile torsion does not need any correction but in severe degree of penile torsion which is more than 90 degrees need correction
- The correction is only in the form of surgery.
About Hypospadias Foundation and Dr A.K. Singal
Hypospadias foundation is one of the best hospital centres for hypospadias repair surgery in India and the world. Over the years and after 15 years and 2000+ hypospadias surgeries, Dr A.K.Singal has refined the techniques and procedures for hypospadias repair, leading to better results and lesser complications even in children having penile torsion or chordee. Children and adults from all over Mumbai, India and other countries come to Hypospadias Foundation at Navi Mumbai, India for the best treatment and care for hypospadias.
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