This is a birth defect in a male child, where the urinary opening is located on the under surface of penis (phallus) instead of tip of glans. The opening (meatus) may be situated anywhere from below the glans to the lower part of the scrotum. The skin fold (prepuce) which covers the glans circumferentially, is absent on the under surface and is only present on the dorsal aspect like a ‘hood’. This malformation is noticed at the time of birth. Many a times, the meatal opening is very small, called ‘pin hole meatus. Depending upon the site of the abnormal meatus on the under surface of phallus, a cordlike structure is present from the opening to the glans which is called ‘chordee’. This causes ventral curvature of the phallus distal to the abnormal opening. Thus, more proximal is the opening, longer is the chordee, causing more bending of the penis.
As the child grows, the effect of above mentioned structures become more evident. What are the problems? (a) Due to pin hole meatus, the child strains to pass urine and later there may be back pressure symptoms of the upper urinary system. (b) Due to abnormal location of the opening, the urinary flow is towards himself soiling the cloths. (c) Therefore, he squats for passing urine unlike normal child. This causes enormous psychological embarrassment. (d) Due to chordee, the penis severely bends ventrally specially during erection leading to deranged sexual function. (e) The organ looks small and abnormal.
Is this correctable? YES. When to get operated? Around 2 to 3 years, before the child goes to school. However, if the patient comes late, it can be done at any age. Depending upon the location of the opening, the operation is done either in a single or multiple stages. The procedure consists of (1) excision of ‘chordee’ and straitening of penis (chordee correction) (2) Reconstruction of urethra up to the tip of the glans (Urethroplasty). The results are very satisfactory and gratifying, both functionally and aesthetically. It should be done by a Plastic Surgeon.
