Paediatric Surgery – Correction of Chordee

Patient Leaflets Team

  • Reference Number: HEY1260/2021
  • Departments: Day Surgery (DSU), Paediatrics

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of your child’s healthcare team.

What is chordee?

Chordee is a condition that a boy is born with which makes the penis bend downwards.

We do not know what causes chordee but during development on the womb more elastic tissue may develop on top of the penis than on the bottom half.  Chordee can also be due to tethering of the skin on the underside of the penis or abnormal development of scar tissue around the urinary tube.  Sometimes with chordee, the urinary opening does not develop at the tip of the penis but on the underside (hypospadias).

Chordee without hypospadias can go undetected for many years as it may only be noticeable during erections.

Are there any alternatives to an operation?

Surgery is the only effective treatment for chordee.  The ideal time for chordee repair is after 2 years of age.

What happens during the operation?

The operation is carried out under a general anaesthetic and lasts between 1 – 2 hours, depending on the severity of the chordee.

The aim of the operation is to straighten the penis by removing the scar tissue and reducing skin tethering.

What are the risks?

All operations have a risk of bleeding and infection.  Your child may be given antibiotics to help prevent infection, but occasionally this can cause the wound to open.  A urinary catheter or tube may be placed during the initial recovery to aid your child passing urine and this can cause bladder spasms, for which you will also receive medication.  Sometime the chordee tissue can recur resulting in a penis with a recurrent bend and the need for further surgery.

How do I look after my child after the operation?

Your child will recover from the anaesthetic and they will be able to eat and drink soon afterwards.  If your child is still in nappies he may come back from theatre wearing 2 nappies.  This is what we call double-nappying; the inner nappy collects stool and has a hole cut out at the front.  Through this hole his penis will poke through wrapped in a dressing.  There may be a thin plastic tube “stent” dripping urine into an outer, second nappy.  This tube is passing through the urethra into the bladder.  If your child is toilet trained he may have a normal urethral catheter.  As mentioned above the urine tubes can cause bladder spasms, which can present tummy pain, discomfort around the penis or bottom area but you will be given medication for this.  We would anticipate your child going home on the day of surgery.

Your child will be uncomfortable for a day or two.  You can pick them up, cuddle them and treat them normally from immediately post operatively. The dressing and drainage tube stay in for at least a week; nursing staff will explain how to look after these before going home.  Baths and showers should be avoided until after everything is removed.  Please be aware, this will smell by the end of the week, this is normal.  If the dressing gets dirty during nappy changes, gently dab off stool with a damp cloth.

Will my child be followed up?

Should your child have severe pain, not improved by medication, oozing from the wound, the dressing falls off, the amount of urine draining reduces or stops or the tube falls out please contact the number given in this leaflet.

If your child has a urinary tube you will need to come back after approximately one week for dressing removal on the ward.  When the dressing has been removed the penis will look red, swollen, bruised this is normal and should settle.

If, however, your child does experience problems such as increased pain, wound becomes increasingly red, hot and swollen, oozing from wound, high temperature or problems passing urine you can either visit your local doctor or get in contact with us via the contact numbers on the following page.  Do bear in mind there is a limit to what staff will be able to advise on without seeing your child. If your child is unwell and you need help as an emergency, you should get them to your nearest Emergency Department.

Should you need any further help or advice please telephone the Day Surgery Service, Monday to Friday 08.00 hours to 18.00 hours (01482) 675066 / 68 / 73 and ask to speak to one of the Paediatric Nurses.  At other times please telephone: Acorn Ward, Women and Children’s Hospital, HRI (01482) 382609 / 382679 or contact the Paediatric Community Team: (01482) 344077

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

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