This tab covers penile curvature (chordee), total penile (phallic) reconstruction, failed hypospadias repair, and reconstructive aspects of genital trauma.
Penile Curvature
"Chordee" means curvature — a relative asymmetry of the erect penis from reduced compliance of one aspect of the tunica albuginea or foreshortening of an erectile body. It is congenital (ventral, lateral, or dorsal — characteristically with a large erect penis) or acquired (almost always from trauma during intercourse).
Acquired curvature that is not Peyronie's disease is thought to follow a subclinical penile fracture: disruption of the outer longitudinal layer of the tunica albuginea during buckling (the inner circular layer staying intact), or disruption of both layers with Buck's fascia preserved. Patients note a pop during intercourse, then painful erections, then (usually dorsal) curvature. Global cavernosal veno-occlusive dysfunction is usually not a complicating factor.
Total Penile Reconstruction
Forearm flaps are the most common method for total phallic construction. Disadvantages include an obvious donor-site deformity, possible cold intolerance in the donor hand, and problematic hair if the forearm is hirsute. Rigidity for intercourse is provided by an external or implanted prosthesis, which is never implanted until ≥1 year after construction — protective sensibility must first be demonstrated in the flap.
Failed Hypospadias Repair
A hypospadias repair may fail from inadequate correction of chordee or an inadequate urethra — with a resulting stricture, fistula, or diverticulum.
Genital Trauma
(Acute management is covered in the Trauma topic.) Penetrating injuries may involve the urethra, the corporeal bodies, or both — with bullet injuries, projectile velocity matters (high-speed rounds may pass through superficial structures with little cavitation). Degloving injuries (penile/scrotal skin stripped from deeper structures) bleed little; the tissues are allowed to demarcate before reconstruction with grafts. Genital burns are managed by careful, repeated debridement (exploiting the penis's unique vascularity) rather than aggressive excision, and genital lymphedema (e.g. after pelvic radiation) can be reconstructed with a split-thickness skin graft.