Severe congenital penile torsion with anterior urethral diverticulum: A case report

Introduction: We present a rare case of severe penile torsion of 180° along with giant congenital anterior urethral diverticula. Presentation of these two rare anomalies together is extremely rare and has not been reported yet. The extreme rarity of the case and its management warrants this presentation. Observation: A 5 years old boy presented to us as a case of epispadias with post-void dribbling and wetting of the underwears. On examination, he was found to be a case of severe congenital penile torsion with diversion and rotation of median raphae in a counterclockwise fashion upto the midline dorsally confirming 180° torsion. During voiding, there was appearance of a swelling in distal penile region with passage of urinary drops while compressing it. Micturating cystourethrogram showed diverticula in penile and bulbar urethra. Torsion was completely corrected by penile de-gloving in a plane between two layers of buck fascia and mobilization of the urethra along with spongiosum proximally upto the penoscrotal junction and distally upto the glans. Diverticula was laid open and underwent urethroplasty along with double breasting of thickened diverticular tissue. Torsion was completely corrected after surgery. Post-operative recovery was uneventful. Urine culture was sterile and uroflowmetry showed maximal urinary flow of 12 ml/s at 3 months postoperatively. Conclusions: Penile de-gloving and adequate urethral mobilization corrects the severe penile torsion of 180°. Correction of severe torsion and urethroplasty is feasible in a single stage with good results. Keywords: Penile torsion, Urethral diverticula, Congenital anomalies, Mobilization of urethra, Urethroplasty, Double Breasting, Correction of penile torsion