A PROSPECTIVE STUDY OF PENILE TORSION WITH HYPOSPADIAS: PRACTICAL ALGORITHM FOR MANAGEMENT

Rama Kishan Saran, Kiran Mirdha, Pawan Katti, Sanya Saran, Rajender Takhar

Abstract


INTRODUCTION: Penile torsion is a rare, less researched topic of urology, owing to its innocuous nature and is
commonly associated with hypospadias. Several procedures are performed for the management of penile torsion.
However, there is scarcity of literature with proper protocol plan, simplified and easy flow of algorithm for its
management.
AIM: The aim of the study was to evaluate the adequacy of correction of torsion and chordee with each step of correction
and also determined the association of degree of penile torsion with the type of hypospadias and severity of chordee.
MATERIALS AND METHODS: This is a prospective study of all patients who have presented with penile torsion with or
without hypospadias from January 2015 to December 2018 and with most patients being previously operated.
Demographic and clinical details including age, type and severity of hypospadias, severity of chordee, degree and
direction of torsion, and routine blood investigation was recorded. Patients were followed for 9 to 48 months (mean 26
months).
RESULTS: Out of the 316 patients operated during the study period, 100 patients had torsion of > 15 degrees with distal
(n=71), mid (n=19) and proximal penile hypospadias (n=10). The incidence of torsion with hypospadias was pretty high
31.64%. The degree of torsion was ranged from 15 to 115 degrees with an average of 52.87 degrees. Left sided torsion
was seen in 71% of the patients and 29% had right sided torsion. Torsion was severe (>90 degrees) in 12.67% of patients,
moderate (45 - 90 degrees) in 44% and mild (15 - 45 degree) in 45% cases. Ventral chordee was present in 58 patients and
ranged from 20 to 122 degrees with an average of 47.27 degrees. The methods of choice for the correction of torque were,
, periosteal anchoring of tunica albuginea (28%), division of the urethral plate (28%) mobilization of the urethral plate
into the glans (25%), mobilization of the urethral plate and the corpus spongiosum (18%), mobilization of the proximal
urethra (16%), correction of the torque were penile degloving (7%), and dorsal plication (2%) performed in step by step
manner, ending with the step when satisfactory correction was achieved.
CONCLUSION: Evidence suggests that though penile torsion is often neglected aspect of reconstructive urology, it
deserves better space in the present literature due to its significant effect in patients with moderate to severe degree of
torsion. A simple step by step algorithm showed effective outcomes in management of patients with penile torsion.


Keywords


Hypospadias, penile torsion, management, treatment algorithm

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References


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