Understanding Chordee Without Hypospadias: Causes, Symptoms, and Treatment

Chordee is a condition characterized by an abnormal curvature of the penis. This curvature may be directed downward (ventral chordee), sideways (lateral chordee), or, rarely, upward (dorsal chordee). While it is commonly associated with hypospadias, chordee can also occur independently, without any urethral opening abnormality.

How Common Is Chordee Without Hypospadias?

Although less frequently diagnosed, chordee without hypospadias is not as rare as it may seem. It occurs in approximately 1 in every 1,500 to 2,000 boys—nearly 10% as often as hypospadias itself. Many cases go undetected, especially if the curvature is mild.

Causes of Chordee Without Hypospadias

The downward or sideways bending of the penis results from disproportion or abnormal development of the penile tissues. Causes may include:

1. Short Skin (Penoscrotal Web)

A common cause, short or tight skin on the underside of the penis can tether it down, creating a ventral bend.

2. Fibrous Bands Under the Skin

Tight, inelastic connective tissue beneath the skin may create tension and force the penis to bend.

3. Tunica Albuginea Disproportion

The tunica albuginea is a strong fibrous layer surrounding the erectile chambers. If there is more tissue on the top than on the underside, this imbalance can lead to downward curvature.

4. Congenitally Short Urethra

The urethra may be too short to stretch during erection, pulling the penis downward.

5. Corporal Disproportion

Uneven development of the corpora cavernosa—the two erectile chambers—can create a structural imbalance, causing curvature toward the shorter side.

Symptoms of Chordee Without Hypospadias

Symptoms vary depending on the degree and direction of the curvature. They may include:

• Noticeable downward or sideways bend during erection

• Deflected urine stream (in lateral chordee)

• Pain or difficulty during erection or intercourse in adolescence or adulthood

• Cosmetic concerns or psychological impact during childhood or teenage years

Diagnosis

Chordee is typically diagnosed during physical examination. In infants and children, it may be identified during evaluation for hypospadias or other urogenital anomalies. In older children and adults, an erection test or artificial erection (conducted under anesthesia) helps determine the angle and severity of curvature.

Treatment Options

The need for treatment is based on the degree of curvature and its impact on function or appearance.

1. Mild Chordee (Curvature <15 degrees)

• Often does not require surgery.

• Regular follow-up during puberty is important to monitor any worsening of curvature.

2. Moderate Chordee (Curvature 15–30 degrees)

• Surgery is generally recommended.

• The first step involves deep degloving, where the penile skin is completely released to allow full assessment of curvature.

• If curvature remains mild after degloving, it can be corrected using dorsal plication—a stitch is placed at the 12 o'clock position to straighten the penis.

3. Severe Chordee (Curvature >30 degrees)

• Requires a two-stage surgical approach:

  • First stage: The curvature is fully corrected, but the urethral opening may shift backward.

  • Second stage: Urethroplasty is performed to reconstruct the urethra and bring the opening to the tip of the penis.

4. Lateral Chordee

• After degloving, curvature is corrected by tunica albuginea plication on the convex side of the bend.

• Typically managed in a single-stage procedure.

5. Dorsal Chordee

• This rare form is treated by ventral tunical plication, placing stitches near the urethra on the underside of the penis.

When Should You See a Specialist?

If you notice unusual curvature in your child’s penis, or if there are symptoms such as difficulty with urination or erection, early consultation with a pediatric urologist is important. Timely diagnosis and appropriate surgical correction can prevent future physical and psychological complications.

About Hypospadias Foundation

The Hypospadias Foundation is a specialized center for the diagnosis and treatment of hypospadias and related penile conditions, including chordee without hypospadias. Since its inception in November 2008, the foundation has treated over 5,000 patients from across India and more than 25 other countries. Located in Navi Mumbai, India, we provide advanced surgical correction, compassionate care, and long-term follow-up for children and adults with genital anomalies.

We manage all types of hypospadias and chordee, including the most complex cases after multiple failed repairs. Each year, more than 250 new patients trust us for safe and effective treatment. Our mission is to restore normal function and appearance with the highest standards of excellence.