Penile Torsion

Penile torsion is a congenital condition where the penis rotates abnormally, usually because of abnormal skin development that is holding the penis in a twisted orientation. It is usually present at birth and can vary in severity, causing cosmetic and potential functional concerns later in life. It is caused by malformation of the skin and connective tissue of the penis while in utero. It is a relatively common concern estimated to affect up to a quarter of male babies, though most cases are mild and do not require treatment. The exact cause of penile torsion is not known.

Symptoms

The symptoms of penile torsion range from mild to quite severe. In the most extreme cases, the penis may rotate 180°. Some common symptoms include:

  • Most children with penile torsion do not have symptoms.
  • Visible rotation of the penis, usually counterclockwise.
  • Difficulty with urination. This may include changes in urinary pressure, a split urinary stream, or most commonly a stream that points in a direction other than straight on.

Diagnosis

Diagnosis of penile torsion begins with a medical history and physical examination by your doctor. Imaging is not usually required for diagnosis.

Treatment

Treatment of penile torsion depends on the severity of the symptoms and parental concerns regarding future penile function. Penile torsion does not improve or disappear with time.

Conservative Management

Observation of mild cases without functional issues.

Surgical Intervention

Procedures to correct rotation are often performed during infancy or early childhood, especially if the rotation is greater than 90°. Techniques include skin rotation and reattachment (degloving) or, for severe cases, more complex reconstructive surgery.

Follow-Up

Regular check-ups following surgery are necessary to monitor healing and function. The penis usually heals within two weeks, during which time parents should follow their pediatric urologic surgeon’s guidelines for taking care of their child. Generally, the prognosis for penile torsion is excellent when under the care of an experienced pediatric urologic surgeon.

Resource:

  1. Eroglu E, Gundogdu G. Isolated Penile Torsion in Newborns. Canadian Urological Association Journal. 2015;9(11-12):E805-E807. doi:https://doi.org/10.5489/cuaj.2833