Congenital penile drop: defective suspensory ligament versus severe proximal curvature, a case series

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.

This work describes a method for discriminating PSL defects from PPC and their surgical management.

Accuracy of preoperative diagnosis and results of surgery in terms of erection angle and penile length.

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.

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.

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.