What is Penile Torsion?
Penile torsion is a rotational defect of the penile shaft, where the penis will appear rotated, or twisted, on its long axis. It has the appearance of a corkscrew, usually making a turn that is around 45 degrees.
Penile torsion is a fairly common congenital defect that can affect any male infant but, is typically seen in uncircumcised infants. In a research study published in the Journal of Pediatric Urology, it was found that the study group of 5018 male newborns the incidence of penile torsion was 1.97%.
Penile torsion may occur alone or present with any one of the following congenital conditions.
- Hypospadias: a condition where the urethral opening is abnormally located on the ventral surface of the penile shaft (caused by the failure of urethral folds to fuse).
- Congenital chordee: a condition where the head of the penis bends and curves downward or upward (also known as Penile Curvature).
- Hooded prepuce: incomplete or poorly developed prepuce (foreskin)
- Mega-meatus defect: a defect where the urethral opening is very large and has a more V-shaped appearance than a slit-like appearance
Causes Penile Torsion:
Penile torsion occurs due to a congenital defect in connective tissue and epidermal development around the 20th gestational week (while the fetus is still in the womb).
Currently, no direct causes have been identified.
It is suspected that excess exposure to female hormones (estrogen, progesterone) can cause disrupt the normal developmental process.
Penile torsion does not usually cause symptoms, especially if the penis is rotated less than 90 degrees. If the penis is rotated 90+ degrees, usually the parents will present to the pediatrician with fears of reproductive issues and or embarrassment later in life.
While penile torsion may cause aesthetic issues, it does NOT cause reproductive issues and rarely issues with urination.
Diagnosis is made based on a physical exam by a pediatrician and/or pediatric urologist.
Treatment options vary based on the degree of torsion. Usually if the torsion is less than 90 degrees, no treatment is necessary; however, many boys will request to undergo treatment for cosmetic reasons. Repair consists of surgical management.
Penile Torsion: Repair and Recovery
Surgical repair is most often done between the ages of 6 months and 18 months, once kids are old enough to have minimal risk of anesthesia, but before school age and old enough to remember the procedure. Most repairs entail dissecting the penile skin off the shaft structures, correcting any tissue bands or webs that are causing the torsion, correcting any associated issues, such as chordee or hypospadias and performing a circumcision. This usually takes about 60-90 minutes and is performed with combined general anesthesia and a caudal regional block. This is done as same-day surgery in almost all cases.
Complications of Surgery
Prior circumcision neither disturbs the operative procedure nor affects the outcomes.
- Poor cosmetic appearance
- Injury to the urethra/meatal stenosis
- Infants under 6 months have a greater risk of complications from general anesthesia.