Evaluation of penile curvature in patients with hypospadias; gaps in the current practice and future perspectives

  • Tariq O. Abbas
    Correspondence to: Tariq Osman Abbas, Pediatric Urology Section, Sidra Medicine, Doha, Qatar
    Pediatric Urology Section, Sidra Medicine, Doha, Qatar

    College of Medicine, Qatar University, Doha, Qatar

    Weill Cornell Medicine Qatar, Doha, Qatar

    Regenerative Medicine Research Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Published:December 31, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.015



      Penile curvature (PC) is a significant phenotypic anomaly associated with hypospadias that can affect hypospadias repair post-operative outcomes and impact on long-term quality of life as well as psychosexual wellbeing of affected patients. While several previous studies have attempted to define PC assessment criteria, there is still no accurate, reproducible, and reliable tool for quantifying severity. Our goal was to review the pros and cons of the current tools utilized for assessing the degree of PC in children, stressing on both strengths and limitations of each method.


      A wide and deliberate review of the literature discussing the assessment of PC in hypospadias patients was conducted. We also draw on relevant methods employed in adults with PC and Peyronie's disease where a greater breadth of studies has been conducted.


      The appraisal outcomes combined with our recommendations were presented in a structured approach discussing the pre-, intra-, and post-operative evaluation of PC in patients with hypospadias. Critical appraisal of the evaluation tools in terms of availability, cost, objectivity, and potential reproducibility was presented.


      This review reflects on current tools used for assessing the degree of PC in children, highlighting both strengths and limitations of each method. A wide variety of approaches are currently being practiced or investigated, with each method displaying particular utility and reliability characteristics. Several approaches are currently being explored with high potential to overcome the current difficulties encountered when measuring PC both in clinical practice and research studies.


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        • Stojanovic B.
        • Bizic M.
        • Majstorovic M.
        • Kojovic V.
        • Djordjevic M.
        Penile curvature incidence in hypospadias: can it be determined?.
        Adv Urol. 2011; 2011: 813205https://doi.org/10.1155/2011/813205
        • Baskin L.S.
        • Duckett J.W.
        • Lue T.F.
        Penile curvature.
        Urology. 1996; 48: 347-356https://doi.org/10.1016/S0090-4295(96)00213-0
        • Abbas T.
        • McCarthy L.
        Foreskin and penile problems in childhood.
        Surgery. 2016; 34: 221-225https://doi.org/10.1016/j.mpsur.2016.03.007
        • Keays M.A.
        • Dave S.
        Current hypospadias management: diagnosis, surgical management, and long-term patient-centred outcomes.
        Can Urol Assoc J. 2017; 11: S48-S53https://doi.org/10.5489/cuaj.4386
        • Spinoit A.-F.
        • Waterschoot M.
        • Sinatti C.
        • Abbas T.
        • Callens N.
        • Cools M.
        • et al.
        Fertility and sexuality issues in congenital lifelong urology patients: male aspects.
        World J Urol. 2020; 39: 1013-1019https://doi.org/10.1007/s00345-020-03121-2
        • Merriman L.S.
        • Arlen A.M.
        • Broecker B.H.
        • Smith E.A.
        • Kirsch A.J.
        • Elmore J.M.
        The GMS hypospadias score: assessment of inter-observer reliability and correlation with post-operative complications.
        J Pediatr Urol. 2013; 9: 707-712https://doi.org/10.1016/j.jpurol.2013.04.006
        • Villanueva C.A.
        Goniometer not better than unaided visual inspection at estimating ventral penile curvature on plastic models.
        J Pediatr Urol. 2019; 15: 628-633https://doi.org/10.1016/j.jpurol.2019.09.020
        • Pippi Salle J.L.
        • Sayed S.
        • Salle A.
        • Bagli D.
        • Farhat W.
        • Koyle M.
        • et al.
        Proximal hypospadias: a persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period.
        J Pediatr Urol. 2016; 12 (e1-28.e7): 28https://doi.org/10.1016/j.jpurol.2015.06.011
        • Snodgrass W.
        • Bush N.
        Staged tubularized autograft repair for primary proximal hypospadias with 30-degree or greater ventral curvature.
        J Urol. 2017; 198: 680-686https://doi.org/10.1016/j.juro.2017.04.019
        • Bologna R.A.
        • Noah T.A.
        • Nasrallah P.F.
        • McMahon D.R.
        Chordee: varied opinions and treatments as documented in a survey of the American Academy of Pediatrics, Section of Urology.
        Urology. 1999; 53: 608-612https://doi.org/10.1016/s0090-4295(98)00656-6
        • Springer A.
        • Krois W.
        • Horcher E.
        Trends in hypospadias surgery: results of a worldwide survey.
        Eur Urol. 2011; 60: 1184-1189https://doi.org/10.1016/j.eururo.2011.08.031
        • Villanueva C.A.
        Ventral penile curvature estimation using an app.
        J Pediatr Urol. 2020; 16: 437.e1-437.e3https://doi.org/10.1016/j.jpurol.2020.04.027
        • Abbas T.O.
        • Vallasciani S.
        • Elawad A.
        • Elifranji M.
        • Leslie B.
        • Elkadhi A.
        • et al.
        Plate Objective Scoring Tool (POST); an objective methodology for the assessment of urethral plate in distal hypospadias.
        J Pediatr Urol. 2020; 16: 675-682https://doi.org/10.1016/j.jpurol.2020.07.043
        • Spinoit A.-F.
        • Poelaert F.
        • Groen L.-A.
        • Van Laecke E.
        • Hoebeke P.
        Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate.
        J Urol. 2013; 189: 2276-2281https://doi.org/10.1016/j.juro.2012.12.100
        • Weber D.M.
        • Schönbucher V.B.
        • Landolt M.A.
        • Gobet R.
        The Pediatric Penile Perception Score: an instrument for patient self-assessment and surgeon evaluation after hypospadias repair.
        J Urol. 2008; 180 (discussion 1084): 1080-1084https://doi.org/10.1016/j.juro.2008.05.060
        • Bethell G.S.
        • Chhabra S.
        • Shalaby M.S.
        • Corbett H.
        • Kenny S.E.
        • BAPSNOAH Contributors
        Parental decisional satisfaction after hypospadias repair in the United Kingdom.
        J Pediatr Urol. 2020; 16: 164.e1-164.e7https://doi.org/10.1016/j.jpurol.2020.01.005
        • Schlomer B.
        • Breyer B.
        • Copp H.
        • Baskin L.
        • DiSandro M.
        Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey.
        J Pediatr Urol. 2014; 10: 672-679https://doi.org/10.1016/j.jpurol.2014.01.024
        • Andersson M.
        • Sjöström S.
        • Doroszkiewicz M.
        • Örtqvist L.
        • Abrahamsson K.
        • Sillén U.
        • et al.
        Urological results and patient satisfaction in adolescents after surgery for proximal hypospadias in childhood.
        J Pediatr Urol. 2020; 16: 660.e1-660.e8https://doi.org/10.1016/J.JPUROL.2020.07.005
        • Abbas T.O.
        • Charles A.
        • Ali M.
        • Salle J.L.P.
        Long-term fate of the incised urethral plate in Snodgrass procedure; A real concern does exist.
        Urol Case Reports. 2020; 32https://doi.org/10.1016/J.EUCR.2020.101216
        • Snodgrass W.
        • Bush N.C.
        Persistent or recurrent ventral curvature after failed proximal hypospadias repair.
        J Pediatr Urol. 2019; 15: 344.e1-344.e6https://doi.org/10.1016/j.jpurol.2019.03.028
        • Wirmer J.
        • Sennert M.
        • Hadidi A.T.
        Ano-Scrotal Distance (ASD) Is it a marker for the severity of chordee?.
        J Pediatr Urol. 2021; 17: 670.e1-670.e5https://doi.org/10.1016/j.jpurol.2021.06.010
        • Gittes R.F.
        • McLaughlin A.P.
        Injection technique to induce penile erection.
        Urology. 1974; 4: 473-474https://doi.org/10.1016/0090-4295(74)90025-9
        • Weber B.A.
        • Braga L.H.P.
        • Patel P.
        • Pippi Salle J.L.
        • Bägli D.J.
        • Khoury A.E.
        • et al.
        Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias.
        Can Urol Assoc J. 2014; 8: 424-427https://doi.org/10.5489/cuaj.2337
        • Kogan B.A.
        Intraoperative pharmacological erection as an aid to pediatric hypospadias repair.
        J Urol. 2000; 164: 2058-2061https://doi.org/10.1016/S0022-5347(05)66965-0
        • McVeigh K.H.
        • Murray P.M.
        • Heckman M.G.
        • Rawal B.
        • Peterson J.J.
        Accuracy and validity of goniometer and visual assessments of angular joint positions of the hand and wrist.
        J Hand Surg Am. 2016; 41: e21-e35https://doi.org/10.1016/j.jhsa.2015.12.014
        • Hsi R.S.
        • Hotaling J.M.
        • Hartzler A.L.
        • Holt S.K.
        • Walsh T.J.
        Validity and reliability of a smartphone application for the assessment of penile deformity in Peyronie's disease.
        J Sex Med. 2013; 10: 1867-1873https://doi.org/10.1111/jsm.12136
        • Acimi S.
        Assessing the degree of ventral penile curvature.
        J Pediatr Urol. 2020; 16: 864-865https://doi.org/10.1016/j.jpurol.2020.10.026
        • Kelâmi A.
        Autophotography in evaluation of functional penile disorders.
        Urology. 1983; 21: 628-629https://doi.org/10.1016/0090-4295(83)90210-8
        • Liguori G.
        • Salonia A.
        • Garaffa G.
        • Chiriacò G.
        • Pavan N.
        • Cavallini G.
        • et al.
        Objective measurements of the penile angulation are significantly different than self-estimated magnitude among patients with penile curvature.
        Int Braz J Urol. 2018; 44: 555-562https://doi.org/10.1590/S1677-5538.IBJU.2017.0418
        • Ohebshalom M.
        • Mulhall J.
        • Guhring P.
        • Parker M.
        Measurement of penile curvature in Peyronie's disease patients: comparison of three methods.
        J Sex Med. 2007; 4: 199-203https://doi.org/10.1111/j.1743-6109.2006.00404.x
        • Greenstein A.
        • Dekalo S.
        • Chen J.
        Penile size in adult men-recommendations for clinical and research measurements.
        Int J Impot Res. 2020; 32: 153-158https://doi.org/10.1038/s41443-019-0157-4
        • Abbas T.O.
        • Ali M.
        Urethral meatus and glanular closure line: normal biometrics and clinical significance.
        Urol J. 2018; 15: 277-279https://doi.org/10.22037/uj.v0i0.4402
        • Park S.
        • Chung J.M.
        • Kang D Il
        • Ryu D.S.
        • Cho W.Y.
        • Lee S.D.
        The change of stretched penile length and anthropometric data in Korean children aged 0-14 Years: comparative study of last 25 years.
        J Kor Med Sci. 2016; 31: 1631-1634https://doi.org/10.3346/jkms.2016.31.10.1631