A fairly common birth defect, penile torsion, occurs in about 1 out of 80 births. Instead of lining up straight at the 6 o’clock position, the penis is rotated. “Torsion” just means twisting. Most penile torsion is towards the left for no known reason. The twist can be very slight or extremely rotated.
Should Surgery be Done?
About half of all newborn baby boys in the United States are circumcised in the hospital even before they go home. Jewish boys of course are circumcised in a religious ceremony on the 8th day after birth.
In the case of penile torsion, the boy should not be circumcised until a specialist can evaluate the degree of torsion. Sometimes penile torsion occurs all by itself, but sometimes it occurs with other penile birth defects and the pediatric specialist must decide on treatment of each problem.
Sometimes the penile torsion occurs with hypospadias. Hypospadias is cases where the urinary opening is not located at the tip of the penis. It may be located farther down the penis, midway down the penis, or even in the scrotum or the anus. The location of the urinary opening is very important before deciding on surgery for the penile torsion.
Penile torsion can also occur with another birth defect called chordee. Chordee is when the penis is curved. Sometimes it also occurs with a misshapen or incomplete foreskin.
Most new parents are anxious to inspect their new babies from head to toe to make sure they are perfect. But sometimes penile torsion is missed, or the parents think it will improve over time. Penile torsion does not get better on its own. Whatever is present at birth is the way it will always grow, unless surgery is performed.
Penile torsion is usually discovered by a doctor at the first visit or when circumcision is being done. It’s important to postpone the circumcision until a specialist can evaluate the torsion and decide if surgery is necessary and if other procedures need to be done at the same time.
Many times parents are worried because they think their boy will be embarrassed by the torsion. Other times parents worry that it will cause reproductive problems. If the torsion is slight, there is no reason for a boy to be embarrassed. Penile torsion has nothing to do with being able to reproduce.
The only day-to-day issue associated with penile torsion is that the child will urinate to the side, depending on the degree of torsion. This could be a minor inconvenience, or if the torsion is pronounced it can be a problem trying to hit the toilet.
When thinking about whether or not to have surgery, consider two facts. The most important fact is the opinion of your specialist. If they think it needs to be done, then it does. The second fact is that if the torsion is slight, it’s best to just leave it alone and not put the baby through unnecessary stress.
Who Does the Surgery?
There are specialists who deal with this kind of problem every day. They are called pediatric urologists. Many times, the pediatric urologist will be fixing other penile problems while they deal with the penile torsion. They may be reconstructing the foreskin, or performing the circumcision, or moving the urinary opening.
The surgery is done using general anesthesia. Because general anesthesia is risky for newborns, penile torsion surgery is usually delayed till the age of 6 months to 18 months.
The surgical methods will depend on the other conditions that the child has. The surgeon may need to correct other issues while they are correcting the penile torsion. If only penile torsion is being treated, it is a pretty straightforward procedure called a phalloplasty. The skin is removed from the patient and then repositioned properly.
If the parents prefer that the child not be circumcised, then the surgery for the penile torsion will be done in such a way as to preserve the foreskin.
The Child’s Future
After a boy has surgery to correct the penile torsion, there should be no further problems. It won’t cause any health problems later, and it won’t cause any reproductive issues later. The same is true if parents decide to not have surgery.