The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion

Abstract Objectives: To evaluate the effectiveness of urethral mobilisation for cor- recting moderate and severe penile torsion associated with distal hypospadias. Patients and methods: Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respec- tively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160) The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisa- tion and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months. Results: All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion com- pletely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)statistically significantly different (P = 0.001), it was not clinically impor- tant. The presence of chordee had no significant correlation with the reduction of penile torsion. Conclusion: Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the com- plete correction of penile torsion.