title: Penile torsion repair in children following a ladder step: simpler steps are usually sufficient.
abstract: OBJECTIVE
  To evaluate the correction of different degrees of penile torsion following a ladder step so that simpler steps are used whenever possible. This can avoid the morbidity and complications of complex procedures.
  
  
  METHODS
  Cases of congenital and acquired penile torsion were repaired on a ladder step basis irrespective of the degree of torsion, starting with degloving and skin realignment, then a dorsal dartos flap and finally corporopexy. The torsion is checked with artificial erection after each step, and if corrected completely then the next step(s) is omitted.
  
  
  RESULTS
  Twenty-five cases of penile torsion (30-180°) were repaired over a 4-year period. Three cases were corrected by degloving only, 12 by degloving and skin realignment, five by a dartos flap and four required a corporopexy. Postoperative complications included five cases of penile edema, one case of hematoma and one case of dorsal skin gangrene. Residual torsion of <15° occurred in three cases. No cases required redo surgery.
  
  
  CONCLUSIONS
  A ladder step approach is a good option for penile torsion repair, starting with simpler techniques until complete correction is achieved. There is no need to plan a complex procedure in advance.
authors.affiliation: Department of Surgery, Tanta University Hospitals, Elgeish Road, Tanta, Egypt. Electronic address: akrammohb@hotmail.com.
authors.forename: Akram Mohammed
authors.initials: AM
authors.lastname: Elbatarny
authors.affiliation: Department of Surgery, Tanta University Hospitals, Elgeish Road, Tanta, Egypt.
authors.forename: Khalid Ahmed
authors.initials: KA
authors.lastname: Ismail
mesh_terms: D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000151:congenital / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D014102:Torsion Abnormality / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Corporopexy; Dartos flap; Ladder step; Penile torsion