• Congenital penile curvature. In: Tekgul S, Riedmiller H, Gerharz E, Hoebeke P, Kocvara R, Nijman R, Radmayr C, Stein R. Guidelines on paediatric urology. Arnhem, The Netherlands: European Association of Urology, European Society for Paediatric Urology; 2009 Mar. p. 22-3. [8 references]

This is the current release of the guideline.

This guideline was originally published in March 2008. It was republished with no changes in March 2009.

Congenital penile curvature

Diagnosis
Treatment

Pediatrics
Surgery
Urology

Physicians

• To outline a practical and preliminary approach to paediatric urological problems
• To increase the quality of care for children with urological problems

Children and adolescents with congenital curvature of the penis

Diagnosis

Artificial erection

Treatment

Surgery

• Chordee release
• Short urethral plate cut
• Plication of corpora cavernosa (orthoplasty)
• Corporoplasty with or without corporotomy

Satisfactory sexual intercourse in adults

Searches of Electronic Databases

The guidelines were based on current literature following a systematic review using MEDLINE.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

1a Evidence obtained from meta-analysis of randomized trials

1b Evidence obtained from at least one randomized trial

2a Evidence obtained from at least one well-designed controlled study without randomization

2b Evidence obtained from at least one other type of well-designed quasi-experimental study

3 Evidence obtained from well-designed non-experimental studies, such as comparative studies, correlation studies and case reports

4 Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities

Systematic Review

Application of a structured analysis of the literature was not possible due to a lack of well-designed studies. Whenever possible, statements have been classified in terms of level of evidence and grade of recommendation. Due to the limited availability of large randomized controlled trials – influenced also by the fact that a considerable number of treatment options relate to surgical interventions on a large spectrum of different congenital problems – this document is therefore largely a consensus document.

Expert Consensus

• The first step in the European Association of Urology (EAU) guidelines procedure is to define the main topic.
• The second step is to establish a working group. The working groups comprise about 4-8 members, from several countries. Most of the working group members are academic urologists with a special interest in the topic. In general, general practitioners or patient representatives are not part of the working groups. A chairman leads each group. A collaborative working group consisting of members representing the European Society for Paediatric Urology (ESPU) and the EAU has gathered in an effort to produce the current update of the paediatric urology guidelines.
• The third step is to collect and evaluate the underlying evidence from the published literature.
• The fourth step is to structure and present the information. The strength of the recommendation is clearly marked in three grades (A-C), depending on the evidence source upon which the recommendation is based. Every possible effort is made to make the linkage between the level of evidence and grade of recommendation as transparent as possible.

Grades of Recommendation

1. Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial
2. Based on well-conducted clinical studies, but without randomized clinical studies
3. Made despite the absence of directly applicable clinical studies of good quality

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Levels of evidence (1a-4) are defined at the end of the "Major Recommendations" field.

Background

Penile curvature may be ventral, dorsal or lateral. Most of ventral curvatures are associated with hypospadias due to chordee or ventral dysplasia of cavernous bodies. Similarly, the dorsal curvature is mostly associated with epispadias. Isolated penile curvature is not frequent with an incidence of 0.6% (Level of evidence: 2). The curvature is caused by asymmetry of the cavernous bodies.

Curvature over 30 degrees is considered clinically significant; curvature over 60 degrees may interfere with satisfactory sexual intercourse in adulthood (Level of evidence: 4).

Diagnosis

Diagnosis is made during hypospadias or epispadias repair using an artificial erection. The isolated anomaly is usually not recognized until later in childhood because the appearance of the penis is normal. The curvature is only observed during erections.

Treatment

The treatment is surgical. An artificial erection is used to determine the degree of curvature and to check the symmetry after the repair.

In hypospadias, chordee related to the tethering of the ventral skin and to the spongiosal pillars is first released. Only in a few cases the penile curvature is caused by a short urethral plate, which should be cut.

To repair the corporeal angulation in the isolated curvature or curvature associated with hypospadias, different techniques of plication of corpora cavernosa (orthoplasty) are used.

In epispadias, a combination of complete release of the urethral body from the corpora and a different kind of corporoplasty with or without corporotomy is usually necessary to achieve a straight penis.

Definitions:

Levels of Evidence

1a Evidence obtained from meta-analysis of randomized trials

1b Evidence obtained from at least one randomized trial

2a Evidence obtained from at least one well-designed controlled study without randomization

2b Evidence obtained from at least one other type of well-designed quasi-experimental study

3 Evidence obtained from well-designed non-experimental studies, such as comparative studies, correlation studies and case reports

4 Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Appropriate diagnosis and treatment of penile erection
• Satisfaction with sexual intercourse in adulthood

Not stated

The purpose of these texts is not to be proscriptive in the way a clinician should treat a patient but rather to provide access to the best contemporaneous consensus view on the most appropriate management currently available. European Association of Urology (EAU) guidelines are not meant to be legal documents but are produced with the ultimate aim to help urologists with their day-to-day practice.

Getting Better

Effectiveness

• Congenital penile curvature. In: Tekgul S, Riedmiller H, Gerharz E, Hoebeke P, Kocvara R, Nijman R, Radmayr C, Stein R. Guidelines on paediatric urology. Arnhem, The Netherlands: European Association of Urology, European Society for Paediatric Urology; 2009 Mar. p. 22-3. [8 references]

Not applicable: The guideline was not adapted from another source.

2008 Mar (republished 2009 Mar)

European Association of Urology - Medical Specialty Society
European Society for Paediatric Urology - Medical Specialty Society

European Association of Urology

Not stated

Primary Authors: S. Tekgül; H. Riedmiller; E. Gerharz; P. Hoebeke; R. Kocvara; R. Nijman; Chr. Radmayr; R. Stein

All members of the working group submit a conflict of interest form. The information is kept on file in the European Association of Urology (EAU) Central Office database. This guidelines document was developed with the financial support of the EAU. No external sources of funding and support have been involved. The EAU is a non-profit organisation and funding is limited to administrative assistance, travel, and meeting expenses. No honoraria or other reimbursements have been provided.

This is the current release of the guideline.

This guideline was originally published in March 2008. It was republished with no changes in March 2009.

None available

This NGC summary was completed by ECRI Institute on November 14, 2008. The information was verified by the guideline developer on December 19, 2008.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

Downloads are restricted to one download and print per user, no commercial usage or dissemination by third parties is allowed.