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