What Is Chordee? Penile Curvature in Hypospadias

Chordee is the downward bending of the penis during erection. Turkish sources call it penile curvature, and in everyday language it's sometimes called a "crooked penis" — all describe the same finding.

There are three separate sources, and more than one can be present together in a single case:

• Skin tightness — the skin on the underside of the penis is too short. Once the skin is released, this component disappears.
• A fibrous band — unhealthy connective tissue beneath the channel. Once it is cleared, part of the curvature resolves as well.
• A length mismatch between the erectile bodies — the underside of the structures that form the shaft is shorter than the top side. This is the most resistant component.

The definitive measurement is made during surgery with an artificial erection test. Saline is injected to produce an erection and the angle is measured; the test is repeated after the skin is released and the band is cleared.

• The usual decision point is around 30 degrees. Curvature below this angle does not affect function; above it, additional correction is needed.

• Skin release (degloving) — the first and simplest step.
• Clearing the fibrous band.
• Dorsal plication — sutures placed on the top surface balance out the length mismatch. Simple; some shortening is expected.
• Adding tissue to the underside (a graft) — the shorter side is lengthened. Length is preserved; the procedure is more extensive.