THREE CASES OF CONGENITAL TORSION OF THE PENIS

Abstract

Since Matsuda's report on a patient with congenital torsion of the penis in 1939, 19 cases of the penile torsion have been recorded in the literature penile torsion can be defined as a congenital malformation of unknown cause, in which there is a rotation of penis around its longitudinal axis. The degree of torsion is usually 90 degrees or less. Torsion can occur on either side.
Presumably because of the infrequent occurrence of this anomaly, little has been written concerning its surgical management, the publications of Culp and Reale being notable exceptions.
Recently we have seen three cases with the penile torsion, in which two cases were monozygotic (eineiig) twins. In an elder (older) brother, chordee and urethral fistula were present, but abnomalities of the external genitalia were not seen in a younger brother. An additional case had marked chordee and coronal hypospadias. However, all other examinations including excretory urography (IVP) were normal in these cases. The penile torsion of the older brother and the other case with significant chordee, urethral fistula or coronal hypospadias, was corrected by using the method described by Culp. A circumferential incision was made around the penis at the site of torsion and the distal shaft was rotated to a normal position. The final result was very satisfactory. The repair of chordee and hypospadias is scheduled 1 or 2 years after the correction of penile torsion. The surgical correction of torsion in the younger brother of the monogerminal twins was not performed because of significant symptoms.
The literature concerning congenital penile torsion has been reviewed and three cases have been added. It is emphasized that congenital penile torsion as an isolated anomaly is usually asymptomatic and rarely requires surgical correction. When associated with significant chordee or hypospadias, it can be corrected by the addition of one surgical procedure to the usual chordee excision and urethroplasty.