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Introduction: Penile drop is a condition where the erect penis is pointing downward. It can either be congenital or posttraumatic. Congenital cases can be attributed to either a defective penile suspensory ligament (PSL) or severe congenital curvature, with the point of maximum curvature proximal, at the base of the penis, concealed within the pubic fat (proximal penile curvature [PPC]). It is important to diagnose the underlying abnormality and choose the surgical approach accordingly, considering that surgical correction of PSL defects results in shortening that can be avoided in PPC cases., Aim: This work describes a method for discriminating PSL defects from PPC and their surgical management., Main Outcome Measures: Accuracy of preoperative diagnosis and results of surgery in terms of erection angle and penile length., Methods: This is a retrospective study of the management of 12 male patients with congenital penile drop. Diagnostic measures were the pubic gap sign: palpation of a gap between the pubis and the penis, the straightening sign: patients with PSL defects can correct the angle of erection while contrary to PPC cases, Sexual Health Inventory for Men (SHIM), and intraoperative trial rotation of the corpora cavernosa that will correct PPC cases and point them out. Accordingly, PSL cases were managed by anchoring the base of the penis to the pubis, while PPC cases were managed by corporal rotation., Results: Penile drop was fully corrected with shortening in PSL group and without in the PPC group. The straightening sign, SHIM, and trial rotation were in agreement contrary to the pubic gap sign., Conclusion: Discriminating PSL defects from PPC is possible by the combination between "straightening sign" and SHIM results. PSL cases should be managed by anchoring sutures despite the inevitable shortening. PPC cases can be spared the shortening by corporal rotation., (© 2011 International Society for Sexual Medicine.)

Introduction: Correction of penile curvature by corporal rotation enabled the correction of 90 degrees ventral curvature with neither shortening nor erectile dysfunction. However, some limitations were described, and only one case was reported upon., Aim: This work described a 3-year experience with corporeal rotation, the modifications addressing and eliminating its drawbacks and limitations, as well as the long-term follow-up of 22 patients., Methods: Modified corporeal rotation was performed in 22 patients with various degrees of curvature. Degree of deviation, erect penile length, symmetry, and erectile function were evaluated and compared pre- and postoperatively., Main Outcome Measures: Correction of curvature, resultant sexual function, penile length, and girth., Results: Full correction of curvature was achieved in 20 out of 22 patients, with no shortening, asymmetry, or erectile dysfunction. Residual curvature in two patients was no more than 10 degrees., Conclusions: Corporal rotation can restore straightness to the penis with no loss in phallic length, asymmetry, or erectile dysfunction. While a variety of surgical techniques are feasible for the correction of milder degrees of curvature, we believe that severe degrees should be spared the shortening and corrected by corporeal rotation.

Introduction: Torsion of the penis is a condition where the penis rotates around its longitudinal axis, whether congenital or acquired. Extreme degrees may provoke a cosmetic complaint., Aim: We describe surgical correction of congenital torsion of the penis in adults, and its prevalence among a special patient group., Main Outcome Measures: Success and ease of surgical repair., Methods: Sixteen cases with congenital torsion were operated upon, by counter-rotation, using a dartos flap in eight cases, and skin realignment in the other eight. The prevalence of congenital torsion was examined in 12,307 patients attending two andrology clinics., Results: Full correction was achieved in all cases. Skin realignment was easier and faster than dartos flap, and was equally effective. Congenital torsion was present in 11.993% of the epidemiologic study group, mild in 80%, moderate in 15%, and severe in 5%. Only 2.2% was bothered by the condition., Conclusion: Torsion of the penis is not uncommon but rarely provokes a complaint. Surgical repair by degloving and skin realignment is effective and easy. Dartos flap technique may be utilized if the former is inadequate.