Overview

What is penile torsion?

Penile torsion is a fairly common congenital (present from birth) condition that can affect any male infant. It occurs more commonly than previously thought, even perhaps up to about 1 in 80 newborn males. It can range from mild to severe. It is most likely to be seen in an uncircumcised penis. Circumcision should not be performed until the child is seen by a pediatric urologist.

With this condition, the infant’s penis appears rotated, or twisted, on its axis. The penis is almost always rotated to the left (counter-clockwise).

Penile torsion can be a stand-alone medical issue, or associated with other congenital conditions of the penis. These conditions include:

Hypospadias (the urethra opening from which the male urinates is not located at the tip of the penis)
Congenital chordee (penile curvature)
Hooded prepuce (a misshapen or incomplete foreskin)

In severe cases with more than a 90 degree rotation, penile torsion should be corrected.

This condition is often noticed in the hospital or doctor’s office during circumcision or an exam. It is important to seek medical advice if you notice your child’s penis appears rotated or twisted.

It is very important to note that if there are concerns for penile torsion, either by the parent or the provider, a circumcision should be postponed until you can talk to a pediatric urologist.

Symptoms and Causes

What causes penile torsion?

Penile torsion happens when the skin and connective tissue of the penis does not form right while the child is developing in the womb. There is no one specific thing that is known to cause penile torsion or other congenital penile conditions. However, over-exposure to female hormones has been found to be in association.

What are the symptoms of penile torsion?

Penile torsion usually causes no symptoms, especially if the penis is rotated less than 90 degrees. Most parents will talk to the doctor because of fears that the infant’s penis will cause him embarrassment later in life due to its appearance, or that he will have reproductive issues. There is no evidence that penile torsion affects a male’s reproductive potential.

Diagnosis and Tests

How is penile torsion diagnosed?

Your pediatrician or urologist will usually be able to diagnose penile torsion simply based on a physical exam.

Management and Treatment

How is penile torsion treated?

Penile torsion usually does not require treatment, especially if the rotation is less than 90 degrees. However, due to cosmetic reasons, many parents of boys with mild torsion may want treatment.

Penile torsion is treated by surgery, done under general anesthesia. This is most often done between the ages of 6 months and 18 months. Infants younger than 6 months have a greater risk for the use of anesthesia.

There are different surgical methods the doctor might use, depending on whether your son has other conditions that also need treatment. Your doctor will advise you on the best treatment for your son. The most common surgical option includes a plastic surgery of the penis known as a “degloving,” with subsequent repositioning the penile skin in such a way as to minimize the appearance of penile torsion.

Outlook / Prognosis

What is the outlook for penile torsion?

Boys with mild penile torsion who do not have surgery should have no long-term health or reproductive issues. The same is true for boys who have their condition surgically corrected.

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Penile Torsion