• Chordee Repair

    Definition

    Chordee repair is a surgery to straighten the penis. It is done to repair a birth defect of the penis called chordee . This defect makes the penis curve downward during an erection.
    A chordee repair is done by a specialized doctor called a pediatric urologist. The surgery is typically done after six months of age if the penis curvature is greater than 30 degrees. Curvature of the penis greater than 60 degrees can affect sexual function later in life.
    The Male Reproductive System
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    Reasons for Procedure

    This procedure is done on male infants born with:
    • Chordee
    • Hypospadias with chordee—the opening of the urethra is on the bottom of the penis instead of at the tip of the penis. Hypospadias can make it difficult for the child to urinate while standing. It can also affect sexual function later in life.
    After surgery, the penis should function normally.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If your child is having the surgery, the doctor will review a list of possible complications, which may include:
    • Shortened penis
    • Bleeding
    • Need for another operation
    • Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
    • Infection (wound infection or urinary tract infection )
    • Psychological trauma
    Discuss these risks with the doctor before surgery.

    What to Expect

    Prior to Procedure

    The doctor may do the following:
    • Physical exam, which may include causing an artificial erection to check the degree of curvature
    • Blood and urine tests
    • Discuss the anesthesia being used and the potential risks
    Talk to the doctor about your child’s medicines and supplements. Your child may need to stop certain medicines before the surgery. The doctor may also ask that your child take certain medicines to prepare for surgery.
    Your child will need to have an empty stomach before the procedure. Ask the doctor when your child will need to stop breastfeeding or eating.

    Anesthesia

    Local or general anesthesia will be used. This will block any pain.

    Description of Procedure

    The surgery is usually done in an outpatient setting. Your child will not need to stay in the hospital overnight.
    Several techniques may be used to straighten the penis. In general, surgery aims to make the longer and shorter sides of the penis equal in length. Techniques may include:
    • Releasing tight, shortened foreskin
    • Suturing extra skin on the longer side with permanent or absorbable stitches
    • Cutting the lining of the urethra if the urethra is short
    An artificial erection will be created using a special injection. This will confirm that the penis is straight. Bandages will be placed around the penis.

    How Long Will It Take?

    About 1-2 hours (longer if your child is having a more complex procedure)

    How Much Will It Hurt?

    Your child will not feel any pain during surgery. The doctor will give medicine after the procedure to manage pain.

    Post-procedure Care

    At the Care Center
    The staff will monitor your child and give him pain medicine as needed.
    At Home
    Swelling of the area is normal. When your child returns home, do the following to help ensure a smooth recovery:
    • Give medicines as directed. This may include antibiotic ointment to put on the penis.
    • Your child should only engage in light, gentle activities while the penis is healing.
    • Keep the bandaged area clean, dry, and protected as directed.
    • Follow all of the doctor’s instructions.

    Call Your Doctor

    After arriving home, contact the doctor if any of the following occurs:
    • Pain that is not controlled with the medicine the doctor has given
    • Redness, increased swelling, or tenderness in the penis
    • Bleeding from the penis
    • Signs of infection, including fever and chills
    • Nausea or vomiting
    • Inability to eat or drink
    • Difficulty urinating or inability to urinate
    • Catheter or stitches fall out
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Pediatrics http://www.healthychildren.org/

    American Urological Association http://www.auanet.org/

    CANADIAN RESOURCES

    Canadian Urological Association http://www.cua.org/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    Agency for Healthcare Research and Quality (AHRQ), National Guideline Clearinghouse. Congenital penile curvature. AHRQ, National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=12595&search=chordee . Published March 2009. Accessed September 14, 2012.

    Elder J. Anomalies of the Penis and Urethra. In: Kleigman R, Behrman R, Jenson J. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 544.

    Hypospadias. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 23, 2011. Accessed September 14, 2012.

    Institute for Sexual Medicine. Congenital penile curvature: chordee. Institute for Sexual Medicine website. Available at: http://sexualmed.org/index.cfm/sexual-health-issues/for-men/congenital-penile-curvature-chordee/ . Updated March 29, 2010. Accessed September 14, 2012.

    Penn State Children’s Hospital. Chordee. Penn State Children’s Hospital website. Available at: http://www.hmc.psu.edu/childrens/healthinfo/c/chordee.htm . Updated October 31, 2006. Accessed September 14, 2012.

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