Penile Torsion
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UTC
What is Penile Torsion and what causes it?
Penile Torsion is a rotation of the shaft of the penis, usually to the left (counter-clockwise) direction. It results in the urethral meatus being placed in an oblique position, such that the median raphe makes a spiral curve from the base of the penis to the meatus. In some cases, penile torsion is associated with mild forms of hypospadias or hooded prepuce.
It is a congenital defect sometimes attributed to the improper extension of the 'Dartos' tissue of the scrotum into the penile shaft. (Dartos tissue is normally found only in the scrotum and is the tissue responsible for reacting to temperature change, contracting when cold and stretching when warm so as to regulate the temperature of the testes.)
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Before correction |
After correction |
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Child patient |
Comparable adult patient |
All images © 2006 Kaohsiung Chang Gung Memorial Hospital, Taiwan |
Treatment
In the past, physicians did not recommend operative correction because they believed that attempts to move the skin would not correct spiral mis-alignment of the corpora cavernosa, the erectile tissue.
Modern thinking differs. In some cases, resection of the Buck's Fascia is needed to provide correction, a procedure now well within the limits of surgical norms in a hospital specialising in paediatric urology. Careful alignment of the skin during closure gives an excellent cosmetic result. The ease of achieving a normal appearance seems to justify surgical correction, especially given the risk of painful or dysfunctional erections in later life if the condition remains uncorrected.
Surgery is best performed between 6 and 18 months of age. Any younger carries increased risks from the required general anaesthetic. Any older and there is the risk of psychological problems resulting from the boy having some memory of his treatment.
Implications regarding circumcision
The corrective surgery may require donor tissue. Therefore it is important that the child is not circumcised neonatally. Surgery to correct the abnormality almost certainly will (and always can) include circumcision. There may, however, be some constraints on the resulting style of circumcision that can be achieved.
Acknowledgements
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