Many congenital abnormalities occur in the male genital organs, such as penile agenesis or testicular agenesis. Some deformities could be minor and may not cause any harm, whereas others can be severe and may require treatment such as surgeries.

Penile torsion is a congenital condition, which means that the boy is born with it. Differences in length between the two corpora cavernosa and torque caused by variation in connective tissue density can also lead to unequal forces applied to the penile skin when the penis is erect, which can lead to penile torsion. The actual problem causing penile rotation is not always easy to establish. 

This condition is rare, where the glans and shaft of the penis are rotated, with the urethral meatus and frenulum being directed upward. It almost always occurs in a counterclockwise direction, i.e., to the left. In most cases, penile development is normal, and the anomaly is not diagnosed until circumcision or until the foreskin is fully retracted. The severity of penile curvature can only be judged when the penis is fully erect. If the penis is not fully erect, the severity of penile rotation may be underestimated. In some cases, penile torsion may be associated with mild forms of hypospadias or redundant foreskin.

Although the glans penis may be twisted more than 90 degrees from the midline, the orientation of the corpora cavernosa and corpus spongiosum at the base of the penis is normal. The cause of hypospadias is unknown. Children with hypospadias may also have the penis and have problems urinating while standing or, as adults, having sexual intercourse. It is usually diagnosed during physical examinations of the baby after birth.

The position of the orifice decides the severity of the hypospadias. In general, the defect has an aesthetic impact, and correction is not necessary unless the rotation exceeds 60 to 90 degrees from the midline. In mild forms of penile torsion, the foreskin can be reoriented by making a circumferential incision at the base of the penis with subsequent disrotation and reimplantation in its normal position. Depending on the severity of the penile torsion, the penile torsion surgery can often be performed in our office under local anesthesia. 

However, in males with torsions greater than or equal to 90 degrees, in which the orifice may be proximal to the base or head of the penis, center of the penile shaft, or even below the scrotum, repositioning the median raphe to its normal position is insufficient to resolve the disorder. For this type of case, penile torsion surgery may need to be performed in the hospital or surgical center under general anesthesia.

This defect is treated by repositioning the meatus and straightening the penile shaft. Generally, penile torsion surgery is done in children at 3-18 months of age. In these severe cases, the base of the penis must be mobilized so that the bands of abnormal tissue are identified and excised. If the penis remains rotated, the correction should be completed with the placement of a non-absorbable suture through the lateral aspect of the base of the corpus cavernosum, in the opposite direction of the abnormal rotation, fixing it from the dorsum of the pubic symphysis to the penile shaft.