Management of chordee in children and young adults.

Penile curvature is a spectrum of disease affecting boys with and without hypospadias. The etiology of chordee includes skin tethering, fibrotic bucks or dartos fascia, corporeal body disproportion and rarely a fibrotic urethra. Several surgical techniques (plication, excision, and graft insertion) are currently employed to repair penile curvature. Recent neuroanatomical studies of the developing fetal penis have shown that the dorsal nerve branches from the 11 and 1 o'clock positions to the 5 and 7 o'clock positions, being absent in the midline. Since the neuroanatomy is similar in both the hypospadiac and normal penis, we now recommend performing penile straightening in both hypospadiac and non hypospadiac patients with significant curvature by the placement of plication sutures at the 12 o'clock position. Placement of dorsal midline plication sutures corrects curvature without risk to the underlying nerve structures.