Congenital genitourinary anomalies of the penis usually involve anatomic anomalies of the urethra and vice versa.
Surgical repair is needed when function is impaired or cosmetic correction is desired.
Chordee
Chordee is ventral, lateral, and/or rotational curvature of the penis, which is most apparent with erection. This anomaly is caused by fibrous tissue along the usual course of the corpus spongiosum, or by a size difference between the two corpora cavernosa. Chordee may be associated with hypospadias.
Severe deformity may require surgical correction.
Phimosis and Paraphimosis
Phimosis, the most common penile anomaly, is constriction of the foreskin with inability to retract over the glans; it may be congenital or acquired.
Phimosis may respond to topical corticosteroids and gentle stretching; some boys require circumcision.
Paraphimosis is inability of the retracted constricting foreskin to be reduced distally over the glans.
Paraphimosis should be reduced urgently because the constricting foreskin functions as a tourniquet, causing edema and pain. Firm circumferential compression of the edematous foreskin with the fingers may reduce edema sufficiently to allow the foreskin to be restored to its normal position by pushing the glans back through the tight foreskin using both thumbs. If this technique is ineffective, a dorsal slit done using a local anesthetic relieves the condition temporarily. When edema has resolved, the phimosis may be treated with circumcision or topical corticosteroids.
Other Penile Anomalies
A very tight frenulum may prevent complete retraction of the foreskin or cause pain or bleeding with foreskin retraction or erection. Frenulectomy may be sufficient to resolve symptoms if patients do not want circumcision.
Less common anomalies include penile agenesis, duplication, and lymphedema. Many penile anomalies also involve a urethral anomaly or other anomalies, such as exstrophy. Treatment of most anomalies is surgical.
Microphallus results from androgen deficiency or insensitivity; in boys with androgen deficiency, treatment is testosterone supplementation. Microphallus should be distinguished from a hidden penis. A hidden penis occurs secondary to the child's suprapubic adiposity. Once the fat pad is compressed, the phallic length is adequate. Surgical intervention is rarely indicated because this anomaly resolves as the fat pad reduces and the phallus grows during childhood and puberty.
