Circumcision of a Penis with Penile Torsion <90º

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Penile torsion is a twisted or rotated penis, usually in the counterclockwise direction. Mild degrees of penile torsion are quite common and are of no consequence. Look at the ventral raphé to see if it is in midline position or rotated counterclockwise. Estimate the degree of torsion. The actual degree of torsion is usually (but not always) less than that estimated by the position of the raphé. See Figure 1 below.

In this image: Figure 1. An example of penile torsion. Mild degrees of penile torsion are quite common and are of no consequence.

Remember, excessive penile torsion, estimated by the raphé position of >90º, is a contraindication to neonatal circumcision using the Gomco bell. The cosmetic result will be suboptimal.

Circumcision of penile torsion <90º. See series of photos below. The key is to place the dorsal clamp about 45º counterclockwise to the apparent 12 o'clock position to approximate where the dorsal midline axis of the twisted penis is.

In this image: Figure 2. An example of penile torsion.

Raphé at about 80°

In this image: Figure 3. An example of raphé at about 80°.

Dorsal clamp about 45° counterclockwise to 12 o'clock midline.

In this image: Figure 4. An example of a finished circumcision with dorsal glans on the right and ventral on the left.

Finished circumcision with dorsal glans on the right and ventral on the left. Approximately 80° of counterclockwise torsion can be seen (Figure 4).

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