What is Chordee?

What Does Chordee Mean?

A penis that suffers from Chordee is one that typically curves or bends sharply upwards or downwards at the head of the shaft. This usually occurs when the penis is in an aroused state (erect). With Chordee, the urinary opening may also be on the underside of the penis also known as hypospadias.

Chordee is a congenital condition that occurs due to abnormal development of the penis in the womb. Congenital Chordee is a birth defect that happens during pregnancy and is relatively common.

A congenital condition is a disease or birth defect that occurs at or before birth. In the case of Chordee, this happens before birth. Congenital disorders are often inherited from a parent.

How Common is Chordee?

Out of every 200 male children born, about 1 will have the congenital condition Chordee. Doctors are able to diagnose Chordee as soon as a male child is born and will then discuss scheduling possible surgery to correct this condition.

Is Chordee Normal?

Yes, with an average of 1 male child out of every 200 born with Chordee that makes the condition quite common and normal.

Chordee Causes

What Causes Chordee?

Chordee is usually caused by the penis suddenly stopping growing while the male foetus is developing during pregnancy. Tissues that form the penis are normally curved at approximately 10 weeks into pregnancy.

If a child is then born with a curved penis this means usually that the tissues may have stopped developing around that time and remained curved according to research.

Is Chordee Genetic/Hereditary?

Genetics may play a role in the development of Chordee in utero, but other than this doctors are not completely sure at this moment what causes the penis tissues to stop growing correctly turning into Chordee.

What is Hypospadias?

Hypospadias is a birth defect where the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is a tube that makes up part of the renal system, that helps urine exit your body from your bladder.

Can Chordee Occur With or Without Hypospadias?

Yes, Chordee can occur with or without hypospadias and typically occurs in male children who have a relative that was also born with the condition.

Can Circumcision Cause Chordee?

Yes, if circumcision is done when a child’s penis is inflamed this can cause Chordee. This occurs because when the penis is healing from circumcision a thick scar tissue can occur which then pulls the penis up or down, causing a curve.

Symptoms & Diagnosis

What are the Signs and Symptoms of Chordee?

The signs and symptoms of Chordee may not be noticeable except during erections. This is typically the case in boys or men who do not also have hypospadias. If a male child does not have hypospadias, then Chordee may go undetected until late childhood or even adulthood.

The most common sign of Chordee is a penis that has a curve upwards or downwards when it is erect. Other possible symptoms of Chordee include:

• Penile torsions – Here the midline raphe (situated on the bottom of the penis) circles around the penis tissue instead of running along the shaft.
• Dorsal preputial hood – In this instance the tissue that usually wraps around the tip of the penis, known as the foreskin, only covers the top half of the penis.
• Skin tethering – This is where the tissue is extremely thin around the urethra near the tip of the penis.
• Webbed penis – An area of webbed skin is created when this occurs, due to the skin on the bottom of the penis being connected to the skin of the scrotum.

What are the Side Effects of Chordee?

Common side effects of Chordee include pain or discomfort during sexual intercourse for both the man and his partner. Another side effect of Chordee is that erections may not be of sufficient quality also for some men who have Chordee.

Is Chordee Painful?

Yes, Chordee can be painful for the man who has this condition, but this is typically only during intercourse.

Can Chordee Cause Infertility?

Chordee on its own is not thought to cause infertility, however, problems can arise if a person with Chordee has hypospadias also. Hypospadias does not directly cause infertility in men, however, severe hypospadias may cause infertility due to accompanying problems with the testicles.

Chordee vs Peyronies

Chordee is a congenital disorder, which means a person is born with it. The condition is also more localised and affects the head of the penis.

Peyronie’s Disease on the other hand is an acquired disorder of the penis, which means it develops after birth with plaque building up resulting in curvature of the penis.

Peyronie’s disease is distinguished by deformity when a penis is erect and can ultimately affect the entire length of the penis (rather than just the head) – it’s most notably with a painful erection and a plaque that forms that is made of a firm disc of scar tissue.

All of these features do not have to be present for a person to have Peyronie’s disease.

Treatment for Chordee

What is Life Like for People Living with Chordee?

If Chordee is the only condition diagnosed, and the curvature of the penis is only mild, then life should carry on as normal for these people and no operations will usually be suggested.

If the condition is more severe, and the curvature is more pronounced, then a simple operation is usually recommended by age two years to correct the issue. Postoperative success is high and goes on to allow all patients to urinate easily and go through puberty normal.

If a person has Chordee with hypospadias which is common, then surgery will be advised also before age 2 to correct both issues. Both scenarios offer a good quality of life, with both situations sometimes requiring follow up operations.

Sometimes complications can occur for severe cases of Chordee who have accompanying hypospadias when it comes to sexual intercourse (being painful) and impacting fertility rates (it can be lowered especially if there are accompanying problems with the testes).

However, diagnosing all issues early and having corrective surgery early can reduce subsequent problems and reduce future complications.

Can Chordee Correct Itself?

Sometimes a doctor may say that surgery isn’t necessary for a child with Chordee when the curve of the penis is only minor. In these instances, a child can go on to urinate properly and can also go through puberty without any complications.

Surgery for Chordee

Chordee surgery is not necessary in every case. For minor cases where there is only a minor curve of the penis surgery is not usually suggested. However, where the curve of the penis is serious then surgery is the only effective treatment to prevent compilations when urinating and going through puberty.

The ideal time for Chordee corrective surgery is before the age of 2 years old. If a person has accompanying hypospadias, then this will be treated and corrected at the same time.

How is a Chordee Repair Done?

Surgery for Chordee can be done as outpatient surgery, which means you can go home after the operation on the same day. Local or general anaesthesia will be used to block any pain during the procedure.

Several techniques could be used during any one Chordee surgery to straighten the penis. Usually, the surgery aims to make the longer and shorter sides of the penis equal in length. This may mean:

• removing tissue that is constricting the erection,
• making the longer and shorter sides of the penis equal in length,
• lengthening the urethra if the urethra is short (here tissue from the foreskin or another site is typically used)

To confirm the penis is straight after the procedure an artificial erection will be created using a special injection. At this point, the operation is considered successful and a bandage will be placed around the penis.

On average a Chordee correction operation will take 1-2 hours, longer if the patient is having a more complex procedure.

The surgeon may ask that the child use a catheter instead of urinating for the first seven days after surgery. Pain medication will be administered to manage any pain and swelling that occurs.

Chordee surgery is very successful in childhood. Some men or older boys may need additional surgery to achieve a final repair of Chordee. When hypospadias is present, additional techniques are used during Chordee surgery to try to move the urethral opening to its proper place at the tip of the penis.

Even if Chordee is diagnosed later in life, Chordee surgery can still be very successful.

How Much is Chordee Surgery?

In America, the cost can range from $25,000 – $50,000. This price depends if you have medical insurance and how much the co-payment is.

Chordee Repair Recovery

No surgery is ever without risk. Listed below are some potential risks from Chordee correction surgery.

• Bleeding – Severe bleeding is rare with Chordee surgery. Special precautions are taken to prevent bleeding during surgery.
• Infection – Although precautions are taken to reduce the risk including using antibiotics in patients who have a catheter, there is still a risk of infection in all who have this operation.
• Bladder spasms – Bladder spasms are common in patients with indwelling catheters. Although used as a safety mechanism, they can be painful after surgery. Medications may be given to help give spasm relief.
• Fistula – It is normal that after Chordee surgery, patients experience a leak of urine from somewhere in the new urethra. This is known as a fistula. The risk of fistula increases the more complex the Chordee surgery was. If a fistula occurs then a surgical repair will be needed after 6 months of the Chordee surgery.
• Stricture or Stenosis – These both involve a narrowing of the urethra, either where the neourethra joins the pre-existing urethra or at the urinary opening. This requires correction by dilation/stretching or by performing an internal urethrotomy.
• Recurrent Chordee – This is an uncommon problem after Chordee repair surgery but if Chordee does return after the first surgery then another surgery may be needed to finally correct the bent penis.
• Diverticulum – This is an out pouching of a newly formed urethra. It can appear like a ballooning of the urethra. Diverticulum can cause infection and will need to be corrected with surgery.