Chordee: Causes, Symptoms, Treatment and Cost

Chordee is a condition in which the penis is bent or curved, usually downward. It is usually present at birth and may be accompanied by hypospadias, a condition in which the urethral opening (the opening through which urine passes) is located on the underside of the penis. Chordee can vary in severity from mild to severe and can cause problems with sexual activity and urination.

There are three main types of chordee: mild, moderate and severe.

• Mild Chordee: Mild chordee typically involves a mild curvature or bend in the penis that does not cause any pain or discomfort.
• Moderate Chordee: Moderate chordee involves a more pronounced bend in the penis that can cause difficulty with urination and sexual intercourse, as well as pain when erect.
• Severe Chordee: Severe chordee is characterized by an extreme bend or curvature in the penis that makes urination and sexual intercourse difficult

• The cause of chordee is not known, but it is thought to be caused by abnormal development of either connective tissue or muscle layers in the penis during fetal development.
• It is believed that hormones may play a role as well, since boys with higher levels of estrogen tend to have more severe curvature.
• In some cases, chordee may also be due to undescended testicles or an abnormally developed scrotum that pulls on the penis and causes it to bend downward.
• In rare cases, chordee can be caused by damage to nerves or blood vessels during surgery or circumcision that affects blood flow and nerve function around the penis.

Common symptoms of chordee include

• a downward curvature of the penis,
• a widened urethral opening,
• ventral (towards the belly) placement of the urethral meatus.
• Other possible signs of chordee include:
• Pain or discomfort during sexual intercourse
• Abnormal urinary flow or spraying during urination
• Difficulty retracting the foreskin over the glans penis
• Abnormal shape or size of the glans penis
• Skin irritation around the penis due to scarring caused by tissue adhesions.

Prevention of chordee can be achieved through proper management of conditions that may lead to it, such as hypospadias or abnormal healing from a circumcision.

It can also be prevented by avoiding any unnecessary tension during circumcision or other urogenital surgeries.

Additionally, good hygiene practices should be followed to minimize the risk of infection, which can cause tissue contraction that may contribute to chordee formation.

Diagnosis can involve physical exams, ultrasound, and MRI imaging.

• Physical exam: The doctor will inspect the penis for any abnormalities, such as an abnormal curvature or other signs of deformity.
• Ultrasound: An ultrasound can be used to measure the degree of curvature and detect any associated tissue damage that could be causing the problem.
• MRI Imaging: MRI imaging can provide a detailed view of the penis and help to determine if there are any underlying conditions that may be causing chordee, such as Peyronie’s disease or cysts.
• Blood Tests: Blood tests may be done to rule out any underlying medical conditions that could be causing chordee, such as diabetes or an infection.
• Urine Tests: Urine tests can help to identify any signs of infection in the urinary tract that could be causing chordee.
• Genetic Testing: Genetic testing can help to determine if there is a genetic cause for chordee, such as an inherited disorder or a chromosomal abnormality.

• Possible complications of chordee include :
• difficulty with urination
• Difficulty in intercourse,
• painful erections,
• an increased risk of infection due to difficulty with hygiene.
• In some cases, chordee can also cause infertility.

Consume turmeric milk regularly.

• Massage the affected area with warm sesame oil for about 10 minutes every day for a few weeks.
• Consume herbal tea made with ginger, cumin seeds, and fennel seeds daily for up to three months to reduce inflammation and help heal chordee.
• Apply a paste of sandalwood powder and water to the affected area before going to bed each night for two weeks or until symptoms improve.
• Consume aloe vera juice or apply its gel topically on the affected area three times daily for up to two weeks or until symptoms improve
• Take ashwagandha tablets as directed on the packaging regularly for up to three months to help reduce inflammation and promote healing of chordee naturally
• Apply a paste of equal parts of garlic, honey, and talcum powder to the affected area.

• Lean proteins such as white-meat chicken, fish, and turkey
• Complex carbohydrates like quinoa, brown rice, oats, and sweet potatoes
• Healthy fats like avocados, nuts, seeds, olive oil and coconut oil
• Fresh fruits and vegetables
• Probiotic foods such as yogurt and kefir
• Fermented foods such as sauerkraut or kimchi
• Whole grains such as barley or bulgur wheat
• Legumes like beans, lentils or peas

• Avoid greasy and fried foods such as French fries, fried chicken, and burgers.
• Limit processed, sugary foods and beverages such as candy, soda, cakes, cookies, and other desserts.
• Limit high-sodium foods such as canned soups and frozen dinners.
• Avoid processed meats such as bacon, sausage, hot dogs, and deli meats.
• Avoid caffeine-containing beverages such as coffee or tea.
• Drink plenty of water throughout the day to stay hydrated and promote regular bowel movements.

The most common treatments for chordee include:

• Tunica albuginea plication :this involves making small incisions in the tissue that holds the penis, and then suturing it to correct the curvature of the penis.
• Tissue release: this involves releasing some of the scar tissue around the penis to help straighten it out.
• Grafting: a graft may be used to replace any missing tissue, or to strengthen any weakened or damaged tissue around the penis.
• Urethral lengthening: this may be necessary if chordee is causing a narrowing of the urethra, as it can help make urination easier and reduce any discomfort caused by urethral strictures.
• Hypospadias repair : this procedure is done when chordee is associated with hypospadias, where there is an abnormal opening on the underside of the penis which can cause difficulty with urination and sexual intercourse.
• Streching exercise: Stretching exercises are one of the most common ways to treat chordee without surgery. Stretching exercises help reduce the amount of fibrous tissue in the area which will help straighten out the penis. When performing these exercises, it's important to be gentle and not force anything in order for them to be effective.
• Steroid Injection: A steroid injection may be used as a short-term solution to reduce inflammation and scarring that may be causing the curvature of your penis.
• Medications can also help improve symptoms associated with chordee without surgery.

If you suspect that your child may have chordee, you should consult with a pediatric urologist. A pediatric urologist is a specialist doctor who is trained to diagnose and treat children with urological conditions such as chordee.

The best medications for chordee include antibiotics, corticosteroids, anti-inflammatory medications, and surgery.

• Antibiotics: Antibiotics can be used to treat an infection that could be causing the chordee. Penicillin is a common antibiotic for chordee.
• Corticosteroids: Corticosteroids work by reducing inflammation and swelling in the penis, which helps to straighten it out. Common Steroids such as prednisone is used to reduce inflammation
• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin may be prescribed to reduce inflammation and pain associated with chordee.

Recovery from Chordee typically takes several weeks to several months, depending on the severity of the condition. In some cases, full recovery is possible without surgery.

The results of chordee treatment are generally permanent, although there is a small risk of recurrence. Surgery to correct chordee involves straightening the penis and releasing the constricting tissue that causes the curvature.

In most cases, this will result in a permanently straightened penis, however some patients may require additional treatments or follow-up procedures to ensure long-term results.Additionally, it is important for patients to maintain healthy lifestyle habits after treatment to reduce their risk of recurrence.

Post treatment guidelines are as follows:

• Wear a protective dressing over the surgical area for at least 48 hours after surgery.
• Take any medications prescribed by your doctor to help manage pain and inflammation after surgery.
• Use cold compresses to help reduce swelling in the area of surgery.
• Wound care and regular dressing changes will be necessary for up to two weeks post-surgery, as directed by your doctor or nurse practitioner.
• Keep the treated area clean and dry at all times until healing is complete (approximately 4–6 weeks).
• Avoid contact sports or activities that may put strain on your penis until you have been given clearance from your medical provider (usually 6–8 weeks).
• Follow up with your doctor periodically to monitor healing and discuss any concerns you may have about post-surgical care or sexual health issues related to chordee correction surgery

The cost of treatment for chordee in India varies depending on the severity of the case and the type of treatment chosen. Generally, simple surgeries to correct chordee can range from 25,000 to 60,000 rupees.

More complex surgeries may cost up to 1 lakh rupees. Additional costs such as hospital stays and post-operative care can add up to the total cost.

Common side effects of chordee treatments may include:

• swelling,
• pain,
• infection
• scarring at the site of surgery.
• Other potential side effects may include
• decreased sensation in the penis
• erectile dysfunction
• and urinary incontinence.

If you are suffering from any complications relating to chordee then you should consult a doctor nearby as they can cause complications like 'urinary tract infections, difficulty passing urine, infertility. 'in which treatment course can range from a few months to years depending on the severity of the situation.