Penile Torsion: an Overlooked Anomaly with Distal Hypospadias

Purpose: To identify the incidence of penile torsion among patients with hypospadias, while using a simple and objective ethod to measure the degree of rotation. Materials & Methods: From December 2007 to March 2009, all boys presenting to our department for hypospadias repair (100 boys) were examined for associating penile torsion. The angle of penile rotation was measured on an end-on digital photograph of the penis, using MillenMed DICOM viewer program for image analysis. Two techniques were used to correct penile torsion. In group A (9 patients), we used the technique of degloving and repositioning the penile skin. In group B (10 patients), we applied the technique of dorsal dartos flap rotation. Results: Penile torsion was present in 19 out of 58 patients with anterior hypospadias (32.8%), while none of 42 patients with posterior hypospadias had associating penile torsion. Follow-up showed satisfactory correction of penile torsion in 3 out of 9 patients in group A; and in 8 out of 10 patients in group B. Conclusion: Penile torsion is a common association with anterior hypospadias (32.8%), and its correction can be simply performed during the hypospadias repair adding to a better cosmetic outcome. Dorsal dartos flap rotation seems to be more effective for correction of penile torsion than simply degloving and repositioning the penile skin. Index Word: penis; hypospadias; abnormalities.