THE JOURNAL OF UROLOGY Vol. 93, Feb.

Copyright © ID65 by The Williams & Wilkins Co. Printed in U.8.A.

CONGENITAL CURVATURE OF THE PHALLUS: REPORT OF THREE

CASES WITH DESCRIPTION OF CORRECTIVE OPERATION
REED M. NESBIT
From the Department or Siirgery, Section of Urology, University of Michigan kleclical Center,
Ann Arbor, ;~Jichigan

Most penile deformities that cause phallic The patient was most anxious to have surgical
curvature or deviation during erection are due correction because he had recently become en-
to chordee such as is common in hypospadias, gaged to be married and had in this alliance
the inflammation of gonorrheal urethritis, or the made the disquieting observation that he could
lesions of Peyronie's disease. Another, rare type not perform coitus.
of penile chordee is that which results from a At operation a circumcising incision was made
congenitally short urethra without hypospadias. which permitted the entire penile skin and sub-
During erection, in such cases, the short urethra cutaneous envelope to be reflected downward to
acts as a bow string and causes marked dmvn- the base of the penis. This maneuver permitted
warcl curvature of the penis. Dr. Hugh Young inspection of both corpora cavernosa and the
saw but one such case during his career and per- corpus spongiosum in their entirety. There were
formed an operation for its correction on a clay no evidences of any abnormal tissue. The fascia
in 1932 when the present author was visiting enveloping each corpus cavernosum was normal
the Brady Urological Institute. Two such cases in appearance and to palpation. Indeed, when flac-
have been seen at the University of Michigan cid, there was no obvious disparity in the dimen-
Hospital and an operation for correction of the sions of the two corpora cavernosa and only when
deformity was reported in 1954. 1 erection was induced under light anesthesia did
Another, and perhaps even rarer type of phallic the deformity become manifest and then there
curvature comprises the subject of the present was no bow string tether on the shorter concave
report. In the 3 cases to be reported there was no side.
chordee or any kind of abnormal structure acting There appeared to be two major alternative
as a bow string or tether. The curvature in these methods of correction: 1) to perform some sort
cases was caused entirely by an asymmetry of of plastic procedure which would lengthen the
dimension in the corpora cavernosa. A compre- short side, or 2) to shorten the longer convex
hensive yet incomplete search of the literature corpus. The latter was elected for practical rea-
has yielded no references to this congenital de- sons and this was accomplished by simple plica-
formity. The present report may be the first tion of the fascia on the lateral aspect of the
description of this unusual anomaly. However, longer corpus. Six vertical rows of plicating
since we have seen three such cases within the sutures of heavy silk were used. These rows of
span of 2 years, it is inconceivable that no other sutures were placed so that there were intervals
cases have been seen or reported. of 1.5 cm. of unplicatecl fascia between the fore-
shortened zones. No fascia was excised for it
CASE REPORTS was feared that the needed excision of multiple
Case 1. A student at the University of Michigan segments from the tunica albuginea might pos-
had noticed all his life that during erection the sibly result in some injury of the erectile tissue.
penis deviated to one side in theshapeofa banana. Following placement of the plicating sutures the
A pencil tracing that he had made during erection covering of the penis was replaced and a few
demonstrated a lateral curvature. Palpation of interrupted sutures, as in a circumcision, were
the penis disclosed no evidences of fibrosis or all that was needed to complete the operation
other abnormalities to explain the deformity. (see figures 1 and 2).
The early result was satisfactory. The patient
Read at annual meeting of American Associa-
tion of Genito-Urinary Surgeons, Rye, New York, experienced no discomfort during erections and
May 6-8, 1964. ,i the penis was straight. After 6 months, the patient
1 Nesbit, R. M.: The surgical treatment of
congenital chordee without hypospadias. J. Urol. reported that a complete recurrence of the erectile
72: 1178-1180, 1954. ' deformity had gradually developed. A decision
230
 CONGENITAL CURVATURE OF PHALLUS

Fm, 1

was made, ,vith the patient's rnncurrence, to ing operation, the patient was still fre<-o of th('
perform another operation to excise several deformity and has more recently marriccL
ellipitical fascia! segments. Case 2 . .,\ 19-year-okl boy ,ms referred hy a
At operation a comiderable amount of scar urological colleague who had heard about our
tissue was encountered at the site of the plicating first case, The deformity in this instance 1Yas
sutures which had obviously pulled out of their different for there was a downward curvature
attar,hments as the corpus cavemosum had with the bend situated in the proximal third of
gradually resumed its original shape and size, the penis and distal to this point the shaft of
Five ,-ertical elliptical segments of the tunica the penis was straight during erection. As in
albuginea were removed from the lateral as]Jed case 1, there was no tether of tissue on the COR·
of the corpus caverno,mm spaced rn as to leave cave aspect of the penis, The deformity appeared
l .5 cm, intervals of fascia bet,veen the defects, to be due solely to a disparity in length between
In dissecting these segnwnts of fascia it was the upper convex fascia and the lower concave
possible to avoid, for the most part, opening the fascia of the corpora,
underlying erectile tissue ,vhic:h appears to be Operative exposure of the deep phallic stn1<>
confined within a very thin endothelial or perhaps tures was again achieved by making u circular
fascia! membrane, The edges of the elliptical incision l cm, proximal to the corona then peeling
defects were closed with No. 2 silk sutures, 4 the mobile skin and subcutaneous strnc:turec.
stitches being used to close each defect. The from the shaft down to the base of the penis.
result was reported to be perfect, _·\ year follmv- There are several large nerves as well as blood

~-·-- ~.--..,-----· - . -- .- ~---...- -

-'"~~.
-,~------~ ~-
232 NESBIT

VEIN

ALBUG!NEA

CORPUS SPONGIOSUM

FIG. 2

vessels on the dorsum which are situated in a associate Dr. Jack Lapides. There was no tether
separate layer of fascia. These structures can be or bow string that could be found. Dr. Lapides
mobilized by careful dissection so as to avoid operated upon the patient using essentially the
injuring them while exposing the tunica albuginea same technique previously described. A color
of the corpora cavernosa. After exposing this cinema film was made of the operation which is
fascia, four symmetrically placed elliptical seg- available to any surgeon who might be interested
ments were outlined on the upper surfaces of the in the technique. A recent report on Dr. Lapides'
2 corpora in the proximal third of the shaft and patient indicates near perfect straightening and,
were excised with only occasional incision into as in the previous cases, no interference with
the erectile structures. Closure of the defects normal erections.
was made with No. 2 silk.
DISCUSSION
During convalescence the patient had erec-
tions and reported that the deformity was no The congenital deformity observed in these 3
longer present. Six months after operation he cases might appropriately be called congenital
reported no deformity whatever during erection curvature of the phallus since this term would
and no discomfort. differentiate it from congenital chordee in ,vhich
Case 3. A third patient with the same deform- a bow string tether is responsible for the deform-
ity as that of case 2 recently has been seen by my ity.