title: The Fisher Technique for Correction of Penile Torsion in Children: Who Are the Candidates?
abstract: OBJECTIVE
  To report our experience in the treatment of penile torsion with a special reference to the Fisher technique.
  
  
  METHODS
  We reviewed 30 cases of congenital penile torsion treated from 2009 to 2015 in a single center. Sixteen patients presented a moderate rotation of 45°-90° and 14 had a severe rotation with an angle greater than 90°. Chordee was present in 17 cases and distal glanular hypospadias in 15 cases. Median age at surgery was 10 months. In 14 cases, degloving along with skin realignment, alone, allowed correction of the torsion. In 16 cases, the Dartos flap (Fisher technique) was used.
  
  
  RESULTS
  Out of the 30 patients, 29 had a good result, with a complete correction of the torsion. Only 1 patient had a residual torsion of 30°. Complications were minor and consisted of skin excess in 11 patients; 1 single case needed to be reoperated for that skin complication. The need for the Dartos flap procedure was significantly correlated to the degree of torsion (P = .001): it was used in 4 out of 16 patients (25%) with a torsion of less than 90°, and in 12 out of 14 patients (86%) with a torsion of 90° or more.
  
  
  CONCLUSIONS
  Most of penile rotations less than 90° can be corrected by skin degloving and realignment. The Fisher technique is a simple and safe procedure for correction of persistent rotation after skin degloving; such cases have usually a penile rotation greater than 90°.
authors.affiliation: Department of Pediatric Surgery, University of Caen Hospital, France. Electronic address: jbaptistemarret@yahoo.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Marret
authors.affiliation: Department of Pediatric Surgery, University of Caen Hospital, France; Caen University Hospital, Avenue de la Côte de Nacre, Caen, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravasse
authors.affiliation: Hôtel-Dieu de France Hospital, Beirut, Lebanon.
authors.forename: Lara
authors.initials: L
authors.lastname: Raffoul
authors.affiliation: Department of Pediatric Surgery, University of Caen Hospital, France; Caen University Hospital, Avenue de la Côte de Nacre, Caen, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Rod
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010409:Penile Diseases / Q000601:surgery*; D010413:Penis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D014102:Torsion Abnormality; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male