Penile Torsion Research Articles

Torsión de pene: A propósito de un caso

To report the clinical characteristics and therapeutic options of penile torsion.We report the case of a male with asymptomatic penile torsion as an incidental finding after consultation for other reasons.The patient was treated conservatively because it was not an important aesthetic trouble and it was asymptomatic.Penile torsion is rare. Surgical treatment is reserved for very important degrees of torsion, symptomatic patients or, when patient feels discomfort with the aesthetic alteration.

Penile torsion repair by suturing tunica albuginea to the pubic periosteum

Purpose The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children. Methods Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. Result Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation. Conclusion The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.

THE FAILED COMPLETE REPAIR OF BLADDER EXSTROPHY: INSIGHTS AND OUTCOMES

We describe the complications of complete repair and their management. A total of 19 patients were referred after failed complete repair. Total dehiscence occurred in 6 males, major bladder prolapse in 3, minor prolapse in 3, pubic separation in 1, impassable stricture in 1, and total hemiglans and corporal loss in 2. Overall, partial glans loss was seen in 7 patients, urethral loss in 5 and penile skin loss in 3. One female had complete dehiscence and 1 had major prolapse, both losing the urethrovaginal septum. One female had an impassable stricture. Six males with dehiscence underwent re-closure with osteotomy. Urethral replacement was performed with full thickness skin graft (FTSG) in 3 and with buccal mucosa in 3. Five patients underwent a modified Cantwell-Ransley (C-R) epispadias repair after placement of skin expanders, and 1 awaits repair. The 3 patients with major prolapse underwent re-closure with osteotomy. A urethral buccal graft was used in 1 patient, FTSG was used in 2 at a later operation and all 3 underwent C-R epispadias repair. Of the 3 patients with minor prolapse 2 underwent re-closure with osteotomy using urethral buccal graft or FTSG followed later with a C-R repair. The final patient with minor prolapse underwent re-closure with osteotomy and C-R repair after testosterone stimulation. One patient with pubic separation and urethral and skin loss underwent re-closure with osteotomy, C-R repair after skin expanders and later bladder neck repair. In 1 case a ureteral graft replaced a posterior urethral stricture. Of the 2 patients with hemiglans and corporal loss 1 underwent penile torsion repair and later hypospadias repair, while the other is being observed. Two females underwent re-closure with osteotomy and urethral replacement with tubularized bladder. The case of stricture was managed endoscopically. Complications of complete repair are similar to those of other repairs but more serious if soft tissue loss occurs. Because of these increased risks, this procedure and its formidable complications are best managed by experienced exstrophy surgeons.

REPRODUCTIVE HORMONE LEVELS IN INFANTS WITH CRYPTORCHIDISM DURING POSTNATAL ACTIVATION OF THE PITUITARY-TESTICULAR AXIS

Testosterone and luteinizing hormone secretion is reportedly impaired in infants born with cryptorchidism. To better characterize this phenomenon, we studied a range of hormones that normally increase in boys during the first few months of life. A case-control study was conducted of boys with nonsyndromic cryptorchidism identified at birth (cases) and boys with descended testes presenting to the urology clinic without endocrine related concerns (controls). Blood was obtained at approximately 2 months of age and up to 3 urine samples were obtained at monthly intervals until age 120 days. Testosterone, estradiol, luteinizing hormone and follicle-stimulating hormone were measured in plasma and urine, and inhibin B, sex hormone-binding globulin (SHBG) and leptin were measured in plasma using standard assays. Data were analyzed using t tests with and without log transformation. Of 20 cases 15 were unilaterally cryptorchid. Although 7 testes descended spontaneously, 2 became cryptorchid again during followup and, therefore, 15 boys required orchiopexy. Diagnoses of 26 controls included foreskin problems (15), prenatal hydronephrosis (4), penile torsion (2), ectopic kidney (1) and hydrocele (1). None of the plasma or urinary hormone measurements was significantly different between boys requiring orchiopexy and controls. Plasma SHBG and testosterone, SHBG, estradiol and leptin, and body mass index positively correlated, while testosterone and body mass index negatively correlated. We failed to identify any significant differences in hormone levels between controls and boys with cryptorchidism during activation of the pituitary-testicular axis in early infancy. These data suggest that impairment of this process may be uncommon in boys with nonsyndromic cryptorchidism.

Penile Torsion Repair Using Dorsal Dartos Flap Rotation

Counterclockwise penile torsion is a frequently noted congenital deformity. Previously proposed techniques of torsion repair are ineffective or pose significant operative risks. We introduce a novel technique using dorsal dartos flap rotation. The penis is first degloved completely and a broad based dartos flap is mobilized from the dorsal penile skin. The flap is rotated around the right side of the penile shaft and attached to the ventral aspect, causing clockwise penile rotation. Final slight adjustments are made during skin closure. We applied this technique in 8 patients undergoing circumcision (2), chordee (4) or hypospadias (2) repair. This technique was effective for correcting penile torsion in all patients. At a mean followup of 8.3 months the cosmetic outcome was satisfactory with the complete correction of penile torsion. Rotational repositioning of a dorsal dartos flap is an effective technique for correcting penile torsion and it is easily applicable with other penile reconstruction procedures.

Developmental Anomalies and Disabilities Associated With Hypospadias

The incidence of developmental anomalies and disabilities associated with hypospadias is still a matter of controversy and data on this issue are sparse. We describe our experience with and evaluation of developmental anomalies and disabilities in a population in which posterior hypospadias was the most common anomaly. We reviewed the records of 356 patients who underwent hypospadias repair from January 1986 through April 2000. Collected data included the Barcat classification of the hypospadias anomaly, anatomical penile variants, associated urogenital and extra-urogenital anomalies, and associated disabilities of physical and mental development. Of the 356 patients 234 (65.7%) had posterior, 88 (24.7%) anterior and 34 (9.6%) mid hypospadias. Anatomical variants, including penoscrotal transposition, bifid scrotum and micropenis, occurred predominantly in patients with posterior hypospadias, while penile torsion was present exclusively in the other 2 groups. Inguinal hernia, which was the most common urogenital anomaly, was distributed evenly among the 3 groups with a prevalence rate of 12.4%. Undescended testis in 26 cases (7.3%) was most often associated with posterior hypospadias. In order of frequency associated extra-urogenital anomalies included congenital heart disease in 19 cases (5.3%), musculoskeletal anomalies in 11 (3.1%), anorectal malformation in 6 (1.7%), cleft palate in 3 and other in 7. In 21 patients (5.9%) associated disorders were related to physical and mental development, including growth retardation in 6, cerebral palsy in 2 and psychological disorders that significantly impaired patient bodily function, behavior and performance in 11. Most extra-urogenital anomalies or disorders were associated with posterior hypospadias. Posterior hypospadias was the most common anomaly in this study. It was associated with a high rate of extra urogenital anomalies, and physical and psychosocial disabilities. The significance of the latter findings with respect to the development of affected patients needs further clarification.

Congenital isolated penile torsion in adults: untwist with plication

To correct congenital isolated penile torsion, we delineated a parabolic curve as a counterdirection to the torsion after artificial erection was induced. Two areas along the curve were chosen and plicated with two interrupted U-shaped sutures. Satisfactory functional and cosmetic results were achieved in 3 patients.

Correction of Complex Penile Deformities by Modified Nesbit Procedure Asymmetric Tunica albuginea Excision

Purpose: Penile angulation combined with penile torsion is an uncommon finding in case of congenital or acquired penile curvature. We describe our technique for treatment of complex penile curvature by the excision of asymmetric ellipses of tunica albuginea.Materials and Methods: During the last 4 years, 4 patients with complex penile curvature underwent surgical correction by the excision of asymmetric ellipses of tunica albuginea. 3 patients had Peyronie’s disease and 1 had congenital penile deviation. They ranged in age from 27 to 63 years.Results: Convalescence was uneventful with good cosmetic correction of the penile torsion and lateral curvature in all patients. 1 patient reported shortening of the penis of about 2 cm, postoperatively. 2 patients reported decreased penile sensation, which resolved after 3 months. Erectile failure did not occur postoperatively in any case.Conclusions: During the last years many Authors have modified the original surgical procedure in an attempt to correct penile deformity. Unfortunately there are very few reports about correction of penile deformities combined with penile torsion. Our modified Nesbit surgical technique for complex deformities differs from the others with regard to the shape of the incision. In this manner, by shortening the longer corporeal body and creating a torque on the penis, it is possible to correct both problems: penile angulation and torsion. The technique is simple, bloodless, safe and reliable. In our experience good cosmetic and functional results have been achieved without complicated surgical interventions.

Treatment modalities for hypospadias cripples.

Hypospadias cripples can be defined as patients with remaining functional complications after previous hypospadias repair. A retrospective follow-up study was performed on the long-term results of a group of 94 patients disabled by hypospadias. The records of 94 patients showed that they presented with the following problems: 82 had a major meatal dystopia (87 percent), 43 (46 percent) had residual curvature of the penile body, 19 (20 percent) showed meatal stenosis, and only 5 (5 percent) had one or more fistulas. The techniques used to solve these problems were circumferential advancement of penile skin, dorsal transposition flap of preputial skin, distally based transposition flap of penile skin, and full-thickness skin graft. Between one and nine operations were needed to achieve the desired result (mean and median of two operations). The complications after these procedures were 11 fistulas in nine patients, meatal stenosis caused by tight scarring in six patients, and a residual curvature after an orthoplasty that had to be released once before a urethroplasty could be performed. Forty-three men were seen at long-term follow-up (range, 2 to 25 years; mean, 12 years). Functional complaints that were seen included spraying at micturition (5 patients, 12 percent), dribbling (6 patients, 14 percent), and deviation of urinary stream (7 patients, 16 percent). No patients complained of painful miction, hesitation, or straining. At physical examination, 4 patients had a residual curvature (three of which were mild without functional problems), 5 had a skin surplus, 1 presented with a fistula after an operation in another hospital, and 13 had a penile torsion. Only 6 patients had a penile torsion greater than 10 degrees, which was evenly distributed to the left and right. There was no correlation between any functional complaint and the presence of a physical abnormality.

Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate

Objectives Results Sixteen patients have returned for follow-up, and all patients have an excellent cosmetic and functional result with an elliptical glanular meatus. There have been no cases of fistula or meatal stenosis. Conclusions Distal hypospadias repair utilizing a de-epithelialized local skin flap to cover a tubularized incised urethral plate gives an excellent cosmetic and functional result. Optimal blood supply to the ultimate skin coverage is preserved, and penile torsion is avoided.

Torsion of the penis

Torsion of the penis, with or without a minor degree of hypospadias, is a congenital abnormality that is being diagnosed more frequently and referred to pediatric surgeons. In the 5-year period 1988–1992, 16 boys, 9 with glanular or juxtaglanular hypospadias and 7 with isolated torsion of the penis, were operated upon for penile torsion in our clinic using either a circular incision at the subcoronal sulcus or Johnston's procedure. The functional and cosmetic results in the two groups are compared and specific indications for the two techniques are discussed. The first technique is suggested as the procedure of choice because it involves minimal complications and gives the best cosmetic results.

Treatment of Congenital Penile Curvature with Penile Torsion: A New Twist

Congenital penile curvature secondary to asymmetry of corpora cavernosal length is an uncommon cause of penile deformity. Although the deformity generally is not severe enough to preclude sexual intercourse it can be a source of great concern to the patient and may cause him to avoid all sexual contact. The Nesbit procedure is a simple, effective surgical technique to correct lateral or ventral curvature. Rarely penile deviation is accompanied by penile torsion. This unique problem requires a novel surgical approach to create a straight, nontwisted erection. We report 2 cases of congenital lateral penile curvature with accompanying penile torsion and describe a simple modification of the Nesbit procedure for surgical correction.

Modification of the One-Stage Flip-Flap Procedure to Repair Distal Penile Hypospadias

SUMMARY The initial results of this modification of the original “flip-flap” procedure, described by Mustarde and further modified by Devine, in 20 children with distal penile hypospadias and mild penile torsion are encouraging. We believe, therefore, that its use is justified.

Surgical correction of torsion of the penis.

Torsion of the penis is a rare anomaly, believed to be due to abnormal skin attachment and not to any structural abnormality of the corpora. The rotation is usually to the left in a counter-clockwise fashion. The urethral meatus is placed in a oblique position and the median raphe makes a spiral curve from the base of the penis towards the meatus. Three boys with congenital torsion of the penis are reported. A corrective operative for this condition is described. Penile torsion was first described by Verneuil in 1857, but in the past no operative correction was recommended, since attempts to move the skin around were believed not to correct the spiral alignment of the corpora cavernosa.

One-stage correction of chordee and 180-degree penile torsion

The surgical management of a patient with 180-degree penile torsion, balanitic hypospadias, and chordee is presented. Complete resolution of the torsion was effected by completely reflecting the penile skin. Correction of the penile curvature was accomplished simultaneously by freeing the corpora spongiosa from the corpora cavernosa.

It is not "Just Circumcision".

Objective:Circumcision is one of the most commonly performed operations during childhood. The procedure is often underestimated in areas where it is frequently executed due to social and religion-based indications. In fact it might be an opportunity to detect and to correct any existing penile anomaly. The aim of the study was to retrospectively evaluate the boys who were admitted to a hospital for circumcision and the outcome of the procedure.Methods:The boys who were brought to outpatient clinics for circumcision between 2009-2015, were retrospectively evaluated. The indications for hospital admission and the presence of associated penile anomalies were searched. All the boys were examined and operated by a single surgeon of the institution.Results:Nine hundred forty four boys were brought to pediatric surgery outpatient clinics in order to be circumcised. The operation was performed in 318 of them. The physical examination revealed penile anomalies in 29 of the 318 cases. The detected anomalies were webbed penis, penile torsion, hypospadias, chordee without hypospadias and meatal stenosis.Conclusions:The proper examination of the boys by a physician prior to circumcision provides the detection of penile anomalies which can be corrected at the same session. The arrangements for performing circumcision in hospitals by the medical staff should be favored. The misleading perception of underestimation of the procedure where it is ritually performed, should be corrected.