Penile Anomalies: A Systematic Review

Background Penile anomalies encompass conditions affecting the size, curvature, number, or appearance of the male external genitalia. Some are congenital, resulting from embryological defects, whereas others are acquired because of trauma or other factors. These conditions are of significant concern because of their potential impact on sexual function and fertility. Methods A systematic PubMed search was conducted from inception through June 2026 using terms related to penile torsion, chordee, inconspicuous penis, buried penis, webbed penis, trapped penis, micropenis, aphallia, and diphallia. Backward citation was also performed. Studies addressing pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, or management were included. Non-English articles, animal studies, letters, editorials, expert opinions, and other descriptive reports were excluded. Study selection followed PRISMA guidelines. Results Of 496 identified articles, 63 met eligibility criteria. Ten studies evaluated penile torsion in 525 patients, and ten evaluated chordee in 706 patients, with surgical correction predominant for both conditions. Three studies evaluated inconspicuous penis in 187 patients. Fourteen evaluated buried penis, three webbed penis and one trapped penis. Seven studies evaluated micropenis in 153 patients, with testosterone therapy and surgical management associated with increased penile length. Ten studies evaluated aphallia in 44 patients, and five evaluated diphallia in six patients; both were frequently associated with genitourinary and other congenital abnormalities. Conclusion Penile anomalies demonstrate differences in presentation, severity, and management of penile anomalies. Treatment ranges from conservative medical therapies to complex reconstructive surgery. Understanding their etiology, pathophysiology, diagnostic evaluation, and appropriate management is crucial for optimizing patient outcomes.