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. 2013 Mar;11(1):1-7.
doi: 10.1016/j.aju.2012.12.004. Epub 2013 Jan 23.

The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

Adel Elbakry  1 , Ahmed Zakaria  1 , Adel Matar  1 , Ahmed El Nashar  1
Affiliations

The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

Adel Elbakry et al. Arab J Urol. 2013 Mar.

Abstract

Objectives: To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias.

Patients and methods: Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75-160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12-18 months.

Results: All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65-130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion.

Conclusion: Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.

Keywords: Chordee; Hypospadias; Penile torsion; Urethral mobilisation; Urethral plate.

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Figures

Figure 1
Figure 1
a, Coronal hypospadias with a penile torsion of 100°; b, The urethra is mobilised down to the level of the scrotoperineal junction using vein retractors; c, A 4/0 polypropylene suture is taken in the lateral border of the right corpus cavernosum and the pubic periosteum to rotate the penile shaft in a clockwise direction, correcting the torsion; and d, An artificial erection showing the corrected torsion.
Figure 2
Figure 2
a, The mobilised urethra is spatulated dorsally to be anastomosed to the triangular distal plate; b, Urethral advancement and anastomosis to the urethral plate up to the glans tip; c, Glanular flaps are approximated and glanuloplasty is completed; and d, Skin closure; the glans closure line is in the midline with the scrotal median raphe.
Figure 3
Figure 3
The optimal correction of penile torsion and a successful hypospadias repair at 3 months after surgery.
None
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