chordee correction Archives - Hypospadias Foundation

February 02 2026

Single stage hypospadias repair in distal penile hypospadias with chordee

Mast A.T., a one-year-old male, presented to the Hypospadias Foundation clinic with an abnormal ventral urinary opening on underside of penis and downward penile curvature. Clinical examination revealed a distal penile hypospadias, deficient ventral foreskin, and
ventral chordee (penile curvature).

A single-stage surgical hypospadias repair was planned, comprising of chordee correction (Orthoplasty) and urethroplasty (reconstruction of the urinary channel)

Intraoperative Procedure

The procedure commenced with a 5-0 Prolene stay suture on the glans for traction. Local anaesthesia (Xylocaine with adrenaline) was infiltrated at the marked incision sites. Following the initial incision and complete degloving of the penis, an artificial erection test was performed to assess the degree of curvature.

 Chordee Correction: A curvature of less than 30 degree was noted. This was corrected via Tunica Albuginea Plication (TAP) on the dorsal aspect (upper part) of the penis, opposite the site of maximum curvature. A repeat artificial erection test confirmed complete correction of the chordee.

 Urethroplasty: The glans wings were marked, incised, and widely mobilized. A midline incision was made in the urethral plate to increase its width (TIP – Tubularized Incised Plate technique). The neo-urethra was constructed in two layers:

o Layer 1: Continuous subcuticular sutures.
o Layer 2: Interrupted sutures.

 Waterproofing: A preputial dartos flap was raised and transposed over the urethroplasty site to provide a vascularized waterproofing layer, significantly reducing the risk of a fistula (leak).

 Completion: Glansplasty was performed to reconstruct the glans. The skin was closed in two layers using 6-0 PDS and 6-0 vicryl Rapide.

Postoperative Outcome and Follow-up

The repair was stented using a 7 Fr infant feeding tube, with the new meatus successfully positioned at the tip of the glans.

 Day 7: The catheter and dressings were removed. The patient demonstrated a strong, straight urinary stream with no associated pain.

 Healing: The surgical site healed by primary intention without complications (e.g., hematoma, infection, or dehiscence).

 1-Year Follow-up: The patient remains asymptomatic with excellent functional and cosmetic results.

Pic 1: Clinical examination shows presence of chordee with meatus in the distal penile region

Pic 2: Complete degloving done

Fig 3: Artificial erection test shows less than 30-degree chordee which was corrected by 12’o clock dorsal tunica albuginea plication (dorsal TAP)

Fig 4: Glans wings raised and urethroplasty done over 7Fr infant feeding tube. Right dartos flap raised and sutured over the urethroplasty with 6-0 PDS.

Fig 5: Single stage urethroplasty with chordee correction completed

Fig 6: At 7 days follow up after surgery

Fig 7: At 1 year follow up after surgery, passing urine in single straight stream

Single-stage hypospadias repair in distal penile hypospadias with chordee Single-stage hypospadias repair is the preferred surgery for distal penile hypospadias associated with mild chordee. Though the urinary opening is positioned near the glans, the reconstruction has to be done with utmost care by the hypospadias expert.Even a little bit of carelessness can lead to complications.

 Primary Technique: The Tubularized Incised Plate (TIP) urethroplasty—commonly referred to as the Snodgrass repair—is the most widely utilized method. This procedure involves a midline incision of the urethral plate to allow for tension-free tubularization, ensuring a functional and cosmetically normal neo-urethra.

 Optimal Age for Surgery: Pediatric urologists generally recommend performing this repair between 6 and 18 months of age. This "golden window" facilitates rapid tissue healing, simplifies postoperative diaper management, and minimizes the risk of long- term psychological impact on the child.

Outcomes and Success Rates

When performed by an expert hypospadias surgeon in a specialized center like Hypospadias Foundation India, the success rate for distal repairs exceeds 95%. However, clinical diligence is required to monitor for potential postoperative hypospadias complications.

Functional Rationale for Early Surgical Intervention

While distal hypospadias may appear manageable in infancy, untreated cases often lead to significant functional and psychosocial challenges as the patient matures:

1. Backward flow of urine: If the urinary opening is located on the underside of the penis, the stream is directed backwards causing inconvenience to the boys. Boys will have difficulty in using a urinal and they cannot urinate without getting urine on their clothes or shoes.

2. Sexual Health: Persistent chordee (ventral curvature) can lead to painful erections or Mechanical difficulties with intercourse in adulthood.

3. Psychosocial Impact: A non-apical urinary opening can cause significant social anxiety and hygiene concerns regarding standing to void.

Clinical Summary: Early repair of distal hypospadias with chordee is not merely cosmetic; it is a functional necessity that ensures optimal urogenital health and quality of life into adulthood.

The Hypospadias Foundation: A Global Center of Excellence

Located in Kharghar, Navi Mumbai, Maharashtra, the Hypospadias Foundation stands as India’s premier and best hypospadias specialty center and a globally recognized leader in hypospadias treatment.

Why Patients Choose Our Center:
For over 18 years, we have been a destination for both pediatric and adult patients from across India and the world. Our commitment to surgical precision and patient care is reflected in our clinical data:

 High Volume: Over 250 specialized surgeries performed annually.

 Proven Safety: A complication rate of less than 5%, significantly lower than the global average for complex reconstructions.

 Global Reach: Successfully treating international patients from more than 30 countries with diverse anatomical challenges.

Our Expert Surgical Team

The foundation’s success is built on the combined expertise of two of the world’s leading specialists in reconstructive urology.

Dr A. K. Singal is a top-tier expert hypospadias surgeon and pediatric urologist who has dedicated his career to the advancement of hypospadias repair. His refined techniques have consistently achieved excellent functional and aesthetic outcomes for both children and adults, particularly in complex "redo" or failed previous surgeries. He is rated the best hypospadias surgeon in India and the world.

Dr Ashwitha Shenoy is an expert pediatric urologist with a sub-specialty interest in pediatric urology and hypospadias. Her meticulous approach to neonatal and childhood reconstruction ensures long-term success from a young age. Together, Dr. Singal and Dr. Shenoy provide a collaborative, multidisciplinary approach that delivers the best results for hypospadias surgery in India.

August 08 2025

Severe penile chordee repair in an adult in a single stage surgery

25-year-old adult presented to the Hypospadias Foundation OPD with complaints of severe ventral curvature of the penis. There were no urinary complaints. He also that the curvature has worsened over time. There were no urinary complaints.. On examination, there was severe ventral curvature (downward bending) of the penis- the curvature was almost 90 degrees. Meatus was located on the glans and was normal in location. No plaques were felt on palpation. Ultrasound doppler of the penis was done which was normal. He was counselled for chordee repair surgery.

The plan was to deglove the penis, examine everything once again in detail including degree of curvature, urethral calibre and then decide for a single stage or a staged chordee correction repair.

Picture 1: Pre-operative assessment showed normal location of the meatus. Second image shows marking for degloving

Surgery was started by taking a stay stitch on the glans with 4-0 prolene. Marking of the degloving incision was done and local anaesthesia (lignocaine with adrenaline) was injected at the marked site. Complete degloving was done. Chordee was assessed by artificial erection test and more than 60-degree chordee was noted. Since the penile length was good and urethra was not appearing short or taut, we decided to proceed with dorsal plicationprocedure to correct the chordee.

Buck’s fascia along with neurovascular bundle was raised on the dorsal side starting laterally and upto the midline. Chordee was reassessed and exact site of curvature was marked. 24 dots (12 dots on either side) were marked. 4 dots proximal and 8 dots distal to the site of maximum curvature. Longitudinal plication sutures were placed at these sites with 4-0 prolene involving full thickness tunica albuginea. The sutures were first held tight without tying them up and chordee was reassessed and there was no chordee. Once we were sure that the chordee is fully corrected, we tied off the sutures and checked chordee again- Chordee was completely corrected by these plication sutures. Buck’s fascia was closed on either side with 6-0 PDS. Circumcision was completed and skin rearranged and closed in 2 layers with 6-0 PDS and 5-0 vicryl rapide. 12Fr silicone catheter was placed per urethra anddressing was done. Catheter was removed after 7 days. At follow up at 6 months after surgery, there was no chordee and the erection was straight.

Picture 2: Complete degloving done and artificial erection test done which showed more than 60-degree chordee.

Picture 3: Neurovascular bundle raised on both sides upto the midline. Marking done, applications sutures placed, held and artificial erection test done. No chordee noted

Picture 4: 24 dot plications completed and circumcision done

Picture 5: Good result- Straign penis at erection 6 months after surgery

Picture 6: Good Cosmetic result 6 months after surgery

Severe ventral chordee in adults: Diagnosis and management

Chordee is characterised by the curvature of the penis, which is noticeable only during penile erection. While chordee can occur in adulthood due to Peyronie’s disease, most of the cases of chordee are present from birth (congenital). Chordee can be missed in childhood, especially if there is no hypospadias. In such cases, men present with challenges in adulthood,d such as pain during erection, difficulty in sexual intercourse and some men can also have psychological implications impacting self-esteem.

In chordee, there is a noticeable bend in the penis during an erection, which can be downward, upward or sideways. The most common chordee type is ventral chordee, where the penis bends downwards, as in the present case. Surgical correction is the only effective method of chordee correction in adults. The goal of the chordee correction surgery is to straighten the penis and restore normal function. Chordee correction can be done by dorsal plication or a ventral lengthening procedure. The ventral lengthening procedure is done if there is a short urethra, which contributes to the penile curvature. If the urethra is normal with good penile length, then dorsal plications are preferred.

In the above-mentioned case, the penile length was good, and the urethra was normal, hence we proceeded with dorsal plication. In this procedur,e multiple (16 or 24) non-absorbable fine sutures are strategically placed on the convex side of the penis. These sutures are placed in pairs and in a parallel fashion to create plications in the tunica albuginea. Neurovascular bundles are carefully raised and saved from any injury before placing the plication sutures.

Important note for adult chordee

It is essential for adults considering chordee correction to have a thorough evaluation by a hypospadias specialist who specializes in penile reconstructive surgery. The surgeon will

Assess the type and degree of curvature, discuss the case and recommend the most appropriate surgical technique whether plication or a staged procedure. At hypospadias foundation, we get adults and children from all over the world in search of treatment for hypospadias and chordee. We provide support and information for children, adults and their families affected by hypospadias. Dr A K Singal is a highly experienced surgeon and regarded as the best hypospadias surgeon in India and in the world. He has dedicated his life towards treating children and adults with hypospadias. His expertise in this area has helped us achieve excellent outcomes in adults and children with hypospadias.

Dr Ashwitha Shenoy is an expert pediatric surgeon with special interest in pediatric urology and hypospadias. Dr Singal and Dr Shenoy are deeply devoted to creating awareness and helping patients get the right treatment for hypospadias be it primary, redo or adult hypospadias. Children and adults from more than 25 countries visit our hypospadias foundation in search for cure and are cured of hypospadias. Both Dr Singal and Dr Shenoy work together to give best results for hypospadias surgery in India for both children and adults.

April 04 2021

Single Stage Repair Surgery for Distal Hypospadias and Penile Torsion

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

A 10-month-old child was brought with complaints of deviation of urine stream and abnormal location of meatus. On clinical examination, there was distal penile hypospadias with severe penile torsion measuring 90 degrees to the left. We planned a single-stage correction for both Surgery for Distal Hypospadias and Penile Torsion, addressing both conditions simultaneously to optimize outcomes efficiently.

Penile torsion

Notice Penile torsion to left

Distal Hypospadias with Penile torsion

Surgery Steps:

Marking of the degloving incision, a crucial step in surgery for distal hypospadias and penile torsion, commenced the procedure. Local anesthesia was meticulously infiltrated at the marked incision site to ensure patient comfort. The surgical process proceeded with complete degloving and assessment of chordee, revealing a 30-degree chordee. Chordee correction was expertly performed through Tunica albuginea plication at 12 o’clock on the dorsal side, resulting in the successful elimination of chordee. Urethroplasty commenced with precise incision of the urethral plate in the midline, followed by meticulous suturing over a 7Fr Infant feeding tube with 6-0 PDS continuous sutures. Additional measures included the harvesting of a Dartos flap for extra coverage over the urethroplasty, secured with 6-0 PDS sutures. Penoscrotal web correction was also addressed, with excess skin excised and meticulously sutured using 5-0 vicryl rapide. To address penile torsion, skin flaps were rotated and adjusted, ensuring optimal alignment, and meticulously sutured all around using 5-0 vicryl rapide. Postoperative care included a 7-day period with dressing and catheter in situ, followed by their removal to facilitate the patient’s recovery.

Penile torsion and Hypospadias repair

Finished Hypospadias and Penile torsion surgery

Surgery for Distal Hypospadias and Penile Torsion

Final outcome of correction of penile torsion and hypospadias

Results

The Final result was very gratifying with a straight penis without any torsion. The child was passing urine in good stream in straight axis without any discomfort or pain.

About Hypospadias repair and penile torsion

Penile torsion is a condition wherein the penis is rotated or twisted on its axis. The penile torsion is more commonly to the left. Many a time penile torsion may not be detected till a circumcision is planned or foreskin is retracted.

Penile torsion may be associated with hypospadias and/or chordee (penile curvature). With hypospadias, penile torsion is mostly associated with distal penile cases.

Based on the degree of glanular rotation, penile torsion can be classified as mild, moderate, and severe. It is mild if its less than 45 degree, moderate if it’s between 45-90 degree and severe if more than 90 degree.

Penile torsion in majority of cases (>85%) is between 10 to 20 degree. If it is a moderate or severe degree of torsion, urine stream may be deviated to one side.

Surgical intervention is not always required in isolated penile torsion. The indications for surgical correction are cosmetic, functional, or sexual. When penile torsion is associated with hypospadias, it should be corrected along with Hypospadias repair or urethroplasty at the same time.

About Hypospadias Foundation

Hypospadias foundation is a centre which provides personalized and best quality care for children and adults with hypospadias. It is one of the best hospital centres in India and world for surgical treatment for hypospadias in adults and children. Our dedication in the field of hypospadias has helped us achieve excellent outcomes in these patients. We treat children and adults not only from various parts of India but also from more than 25 countries all over the world. Hypospadias foundation is located at MITR hospital in Kharghar, Navi-Mumbai, Maharashtra, India. Every year more than 200 surgeries for hypospadias are performed at MITR hospital and Hypospadias Foundation

Contact us:

For appointment kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India
MITR Clinic: C1/8 Ground floor, Sector-2, VashiCall

Call for appointments: +91-2227743558/ 27744229/ 39/69 and +919324180553.

Or you can fill up this form- Contact form for Dr Singal

Fill up contact form: https://www.hypospadiasfoundation.com/contact/

April 04 2015

Long journey from Patna to Navi Mumbai: Severe scrotal hypospadias managed successfully at Hypospadias Foundation

Hypospadias is one of the most common urological anomalies in boys. While 80% of all hypospadias are mild and of distal or midpenile, 20% are proximal hypospadias. Severe varieties like scrotal hypospadias form only 5% of total burden of hypospadias. Severe hypospadias such as scrotal hypospadias often have associated chordee (bent penis) and this may be very severe too posing a challenge for the hypospadias surgeon. We have realized in last few years that making the penis straight (chordee correction) is THE MOST IMPORTANT step of hypospadias repair procedure. While most of the severe scrotal hypospadias are also repaired in a single stage (almost 90% are suitable for a single stage urethroplasty), in 10% of the children the anomaly is so severe especially due to severe chordee that two stage repair may be better for an optimal long term outcome.

Master R.P. was born with scrotal hypospadias, severe chordee in Patna, Bihar and was advised to undergo surgery after 1 year of age. The parents went to multiple doctors in Patna, Delhi and finally came to consult Dr A.K.Singal, renowned Hypospadias surgeon at MITR Hospital, Navi Mumbai. On examination, the child had a severe scrotal hypospadias, severe chordee (almost 90 degrees) and abnormally fused skin of scrotum to the penis. This almost looked like a trapped hypospadias penis due to skin shortage. Dr Singal discussed in detail with parents that such a severe hypospadias may require hypospadias treatment in stages. Due to the severity it may be impossible to correct all the defects in one surgery. Also the penis length may have got shortened and cosmetic result would also been suboptimal.

Finally, R.P. was taken under anesthesia and hypospadias repair surgery was started. As a first step the penis was degloved. Urethral plate was divided and the fibrous bands causing chordee on the underside of penis were divided deeply till the scrotum. The penis was almost straight after this maneuver with just 30 degree bend which was further corrected by a placing a placating stitch on the top side of penis (tunica albuginea plication or TAP). Artificial erection test confirmed the complete correction of chordee. Since the chordee was severe and the urethral plate was also divided, single stage surgery would have carried very high failure rates. Hence, a staged urethroplasty was planned. The skin on the top of the penis was divided in midline and brought to the underside of penis. A part of the skin was advanced into the head of penis (glans) so that the new urethra in next stage would be constructed till the tip of penis. This is called Thiersch Byar’s urethroplasty stage-1. There was a compression dressing done which was removed after 7 days and the family travelled back to Patna after a total of 14 days after first hypospadias surgery.

Happy family with Dr Singal after Surgery

The family sent us some pictures in the healing phase over next few months and the second stage urethroplasty was planned after 6 months of first hypospadias surgery. When we saw the patient again – the flaps and the skin on the underside was very well healed and ready for second stage. Second stage urethroplasty was done and it took just 2 hours for the surgery. The catheter was removed after ten days and the R.P. passed urine in a good stream from the tip of the penis like a normal boy. Family was delighted and after another follow-up visit one week later they travelled back to Bihar.

According to Dr Singal, “With the experience and expertise, currently we do single stage surgery for even scrotal hypospadias and other complex hypospadias. The only limiting factor is the severity of the chordee. Sometimes in sever chordee we need to apply a cut on the underside of penis to straighten it. In such cases, it is better to do a staged repair. In our experience, two stage hypospadias surgery can have excellent cosmetic and functional results. It also provided a longer penis length by straightening the penis and elongating the underside of penis when chordee correction is done.

About the author:

Dr A.K.Singal is a senior Pediatric Urologist and a renowned Hypospadias expert surgeon in Navi Mumbai, India. Every year he operates more than 200 kids and adults with hypospadias from all over the world and from all over India. Dr Singal has done lot of clinical research and conducted training programs for hypospadias surgery in India. Due to expertise in managing complex cases of severe hypospadias and failed hypospadias operated elsewhere, he is counted as one of the best and top hypospadias surgeons in India.

Dr A.K.Singal delivering his talk at ESPU

About Hypospadias Foundation:

Hypospadias Foundation is World’s first and only organisation dedicated to care and cure of children and adults with hypospadias. Started in 2008 by Dr Singal and Dr Dubey, more than 1000 patients have benefitted from care at the foundation from more than 20 countries. The blessings and goodwill only continues to grow from a single point focus of excellence in hypospadiology. The foundation soon intends to start formal training courses in Hypospadias surgery for international doctors.

To contact us you can

Email us at hypospadiasfoundationindia@gmailcom

Or Call Dr Rajkumar, Coordinator, at +91-9821261448 between 10am-4pm.

Else you can fill up this form: Contact Hypospadias Foundation

Watch video of Scrotal hypospadias surgery repair by Dr Singal

Watch video of Proximal penile hypospadias surgery by Dr Singal

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

1 2 Next page

Tag Archives: chordee correction

Contact Form for Hypospadias Foundation