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I was told my son has a chordee. Is it serious?
Chordee is an anomaly of the penis comprising excess curvature / bent either downwards or towards the side. The skin is often tight around the urinary tract opening. This causes a curved erection which may be painful and spraying of urine (this wets the pants when the child is standing to pee). The reported incidence ranges from 1 in 100 to 1 in 1000. Chordee is not life threatening but may be associated with other anomalies.
What other anomalies can pediatric chordee be associated with?
A chordee may be associated with hypospadias, undescended or absent testis, or positional anomalies of the penis and scrotum. These should be diagnosed and managed by a paediatric surgeon / urologist.
Can medicine cure chordee?
No, it is corrected only with surgery to ensure normal urine and sexual function.
When is the best time to correct chordee in a child?
There is no consensus on the best age for paediatric chordee repair. The best time is before the child becomes aware of himself, to minimize the psychosocial effects of the condition and its treatment. Classically, surgery was proposed to be done from 6 to 18 months old although there is no current good evidence for that. When the child presents at an older age, I recommend repair as soon as it is possible. The outcome is similar in terms of wound recovery and appearance.
What happens during the surgery?
Chordee repair is performed under general anaesthesia. The aims are to repair the excess curvature (chordee), ensure the urinary opening is at the tip of the penis, and repair any rotation anomaly. An artificial erection test is performed to determine the severity of chordee. Depending on the extent of the bent penis, multiple layers need to be repaired, see Figure 1. If the urinary passage (urethra) is foreshortened, it needs lengthening and repair (urethroplasty). A urinary stent may be inserted as part of the surgery. A dressing is placed over the penis. The final outcome is a normal penis on erection and a circumcised appearance.
How is the follow up care post chordee repair?
It is important to prevent your child from pulling off the stent or dressings. Your child needs the painkillers only for the first 1 – 2 days. Minimal bleeding is expected. Please ensure good fluid and fibre intake, because these prevents discomfort from constipation. The dressings and urinary stent may be removed in 1 to 2 days’ time, and your child can be discharged from hospital. If a urethroplasty is performed, the stent may be kept for 7 to 14 days, and can be managed as an outpatient by the parents. Care is easy with normal bath / shower and keeping the stent in a diaper. The follow up is in 1 week, and subsequently 2 weeks, after surgery.
Are there alternative treatments?
Unfortunately, no medicine cures a chordee. In the past, before advances in surgery and anaesthesia, this condition was likely left alone. The patient may experience deviant urinary stream and pain during erection or sexual intercourse. There is no good evidence in the literature to tell how these patients coped with it or whether fertility was an issue.
Figure 1: The Skin, Dartos fascia, Buck’s fascia and Corpus cavernosum may contribute to the excess curvature (chordee) and needs to be repaired. The urinary passage (urethra) may be foreshortened and needs lengthening (urethroplasty).
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