Penile torsion

　　First, etiology

　　The occurrence of congenital penile torsion may be caused by the uneven development of the corpora cavernosa during the formation of the penis due to the imbalance of the reproductive nodes. The vast majority are counterclockwise torsion, and the urethral orifice and the prepuce are often twisted to one side at the same time. According to the angle of deviation of the glans penis from the median line, penile torsion is divided into the following three categories:

　　1. Mild torsion of the glans penis deviates from the median line by less than 60°, urination is normal, and there is no obvious deformity in appearance.

　　2. Moderate torsion of the glans penis deviates from the median line between 60° and 90°, and the appearance and urinary function of the penis are abnormal.

　　3. Severe torsion of the glans penis deviates from the median line by more than 90°, and the appearance of the penis is obviously deformed, which can cause difficulties in urination. Most of the corpora cavernosa and urethral corpora spongiosa also appear twisted.

　　Second, pathogenesis

　　There is currently no relevant information

　　The complications of this disease, which is purely itself, mainly affect the function of the organs. Due to the asymmetric development of the corpora cavernosa, the clinical manifestations are mainly pain during penile erection, pain during sexual intercourse, and changes in the shape of urination. Occasionally, there may be complications such as missing testicles or cryptorchidism. This disease can also be complicated with hypospadias, and may be accompanied by symptoms such as urinary tract infection.

　　During penile twisting, the direction of the urethral orifice changes, and a few patients may have a hidden pain symptom during erection. Generally, there are no symptoms, which do not affect sexual function, but occasionally, urethral stricture or obstruction may occur due to twisting, leading to bilateral renal积水. Penile twisting is divided into three categories according to the angle of deviation of the glans from the median line: ①less than 60°; ②60°～90°; ③greater than 90°. Some patients may have a normal penile body direction but a glans twisted greater than 90°.

　　The etiology of this disease is not yet clear and may be related to environmental factors, genetic factors, dietary factors, and emotional and nutritional factors during pregnancy. Therefore, it is not possible to prevent the disease directly based on the etiology. Early detection, early diagnosis, and early treatment are of great significance for indirect prevention of the disease. Avoid using tight diapers and tight underwear during infancy to prevent compression of the penis and testicles, which can reduce the incidence of the disease.

　　Penile twisting is often found during circumcision or inversion of the prepuce, and diagnosis can be established based on the sign of the glans deviating from the median line and twisting to one side. Other urogenital malformations should be carefully examined and excluded.

　　It is forbidden to eat spoiled food and vegetables containing pesticide ingredients during pregnancy. Pregnant women should be prohibited from using cosmetics containing heavy metals, as these substances can be absorbed by the skin and mucous membranes of pregnant women and pass through the blood-fetal barrier into the fetal blood circulation, affecting the normal development of the fetus and causing deformities. It is recommended to eat more fruits and vegetables and have a diet rich in high-protein and high-nutrition.

　　If the first class of patients does not affect the appearance and function of the penis, treatment is not necessary. Most 1st and 2nd class patients require surgical correction, which involves making a circular incision in the penile skin above the glans, separating the skin and stripping it down to the root of the penis, correcting the twist to the median line, and suturing the penile skin. However, the effect is not good for cases where the penile twist is greater than 90°. Some may require exposing and releasing the corpora cavernosa at the root of the penis, and removing the fibrous bands that cause the twist. If still not satisfied, the twisted side of the penile corpora cavernosa and the pubic symphysis can be fixed with non-absorbable suture to achieve the purpose of plastic surgery. Correction should be made for hypospadias or other deformities.