What Is Penile Torsion?
Penile torsion is a common congenital condition (from birth) that is mainly seen in male infants. It affects one male infant out of 80 male newborn babies. It ranges from mild to moderate to severe. The most distinguishing feature of this condition is penis appears to be rotated or twisted along its long axis. Penis is, by birth, turned to the left side in a counterclockwise direction. It is primarily seen in the uncircumcised penis. Therefore it is essential to note that the child should be taken or visited by a pediatric urologist before performing the procedure of circumcision.
It is caused by skin or dartos adherence or buck’s fascia attachment. If penile torsion is less than 20 to 30 degrees, surgical correction is not recommended. In severe cases where the rotation is around 90 degrees or more, then penile torsion should be corrected by surgery. Various methods for correction of penile torsion are:
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Penile shaft skin rotation.
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Suturing tunica albuginea to the periosteum of the pubis.
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Dorsal Dartos flap rotation.
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U-shaped plication suture.
Doctors diagnose this condition during physical examinations or circumcision procedures. It is very important to check the shape of a child’s penis to detect any rotation or twists. If found, any immediate consultation with a doctor is necessary. If parents notice any kind of penile torsion, the procedure of circumcision should be postponed until a pediatric urologist’s consultation, and circumcision should be performed only after approval from the doctor. Penile torsion can be a stand-alone medical issue or can be in combination with other congenital medical conditions:
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Hypospadias: It is a condition where the opening of the urethra from where the male urinates is not present at the tip of the penis.
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Congenital Chordee: In this condition penis is curved.
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Hooded Prepuce: The foreskin of the penis is incomplete.
What Are the Causes of Penile Torsion?
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Penile torsion occurs when the skin and connective tissue of the penis do not fuse properly when the child is developing in the mother's womb.
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Overexposure to female hormones is known to be one of the causes of penile torsion.
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Genital malformation.
What Are the Symptoms of Penile Torsion?
No such symptoms are known for penile torsion, particularly if the penis is rotated or twisted less than 90 degrees. It may show specific signs such as a twisted or turned appearance. In most cases, parents are of the utmost concern that the shape of the penis might cause embarrassment in the future. Or that their child might have a reproductive issue due to penile torsion. But there's no confirmed evidence that penile torsion can lead to infertility in any of the cases.
How to Diagnose Penile Torsion?
There is no particular way to find or diagnose the penile torsion condition. Only a physical examination by a qualified professional doctor is required.
How Is Penile Torsion Treated?
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Penile torsion does not usually require surgery, mainly if the rotation is less than 90 degrees. But for cosmetic reasons, the child's parents might want to get it treated.
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Penile torsion surgery is generally done under general anesthesia between the age of 6 to 18 months because infants under six months are at risk under general anesthesia. Penile torsion surgery is classified according to the angle of torsion. For moderate cases, penile degloving and reattachment, and in resistance cases, dartos flap technique is considered.
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The doctor might choose different surgical procedures depending on whether the child has one condition or several other conditions that might require treatment.
The most common surgical options include plastic surgery of the penis, known as degloving. And they were repositioning the penile skin to reduce the appearance of penile torsion.
Penile degloving and reattachment is a preferred surgical technique, and dorsal dartos flap technique is used to correct the pathology. Parents with the children are called after seven days of surgery to reevaluate the procedure. No other complications or side effects have been seen associated with penile torsion surgery.
How Is Degloving Performed?
The penis skin is degloved till the base, and an artificial erection is performed. If the degloving method resolves the penile torsion, the penis is placed straight by over-rotating the skin to complete the repair. An inverted permanent braided four to zero diagonal folded suture is placed parallel to the neuromuscular bundle to the right corporal cavernous (two columns of spongy tissue which are present along the body of the penis), and the other half of the suture is placed parallel to the left corporal cavernous body. By this procedure, where the neuromuscular bundle is secured through a diagonal fold suture, penile torsion is corrected. If the torsion stays, an additional suture is placed. Scarring can occur by permanent storage before the suture loses tension. An incision over the tunica albuginea on the corpus along the folded suture helps to allow the fresh cuts and the folds to heal completely and permanently.
Conclusion
A genetic flaw of the penis called penile torsion causes the penis shaft to rotate. Penile torsion is a condition where the penis is turned or twisted along its long axis. It can be congenital. Penile torsion less than 20 to 30 degrees is negligible and does not require surgery, but a surgical procedure is done if the degree of rotation is more than 90 degrees. This is mainly caused due to genital malformation during the child's growth in the mother's womb. Parents of children with minimal torsion may seek correction of torsion to avoid future embarrassment to their child. There is no infertility linked with penile torsion males having torsion can reproduce without any problem. It is most commonly seen in the uncircumcised penis. Therefore it is very important to consult a doctor before any circumcision procedure. Penile torsion, if mild and not corrected, does not show any complication or risk, the same if corrected by surgery, also does not involve any risk of complications such as infertility. It is a safe procedure carried out only in babies of 6 to 18 months.
