Megameatus intact prepuce and associated anomalies

Öz

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies . Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques. Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology.

Anahtar Kelimeler

• Megameatus intact prepuce,,associated anomalies

Kaynakça

1. 1-Juskiewenski S. Vaysse P, Moscovici J. Treatment of anterior hypospadias. (Balanoplasty) (Article in French). J Urol. 1983;89:153-156
2. 2-Duckett JW, Keating MA. Technical challenge of the megameatus intact prepuce hypospadias variant: the pyramid procedure. J Urol. 1989;141:1407-1409
3. 3-Peretz D, Westreich M. Pseudo-iatrogenic hypospadias: the megameatus intact-prepuce hypospadias variant. Plast Reconstr Surg. 2003;111:1182-1185
4. 4- Fahmy M, Shenaway A, Altramsy A, Al Samahy O, Yehya A, Othman D. Penile median raphe anomalies as an indicator of megameatus intact prepuce anomaly in children undergoing routine circumcision. Urology. 2018;121:164-167
5. 5-Fasse MA, Dray EV, Cheng EY. Repair of megameatus : a modified approach. J Pediatr Urol. 2015;11:100-101
6. 6-Bhat A, Bhat M, Bhat A, Singh V. Results of tubularized urethral plate urethroplasty in megameatus intact prepuce. Indian J Urol. 2017;33(4):315-318
7. 7-Bar-Yosef Y, Binyamini J, Mullerad M, Matzkin H, Ben-Chaim J. Megameatus intact prepuce hypospadias variant. Application of tubularized incised plate urethroplasty. Urology 2015;66(4):861-864
8. 8-Hill GA, Wacksman J, Lewis AG et al. The modified pyramid hypospadias procedure: repair of megameatus and deep glanular groove variants. J Urol 1993;150:1208-1211

9. 9-Attalla, FM. Subcoronal hypospadias with complete prepuce: a distinct entity and new procedure for repair. Br J Plast Surg. 1991;44:122–125
10. 10-Cendron M. The megameatus, intact prepuce variant of hypospadias: use of the inframeatal vascularized flap for surgical correction. Front Pediatr 2018;6:1-5
11. 11-Hatch DA, Maizels M, Zaontz MR, Firlitt CF. Hypospadias hidden by a complete prepuce. Surg Gynecol Obstet. 1989;169:233-4
12. 12-Nonomura K, Kakizaki H, Shimoda N et al. Surgical repair of anterior hypospadias with fish-mouth meatus and intact prepuce based on anatomical characteristics. Eur Urol 1998;34:368-371
13. 13-Horst H.J.R.,Wall L.L. Hypospadias, all there is to know. Eur J Pediatr 2017;176:435-441
14. 14-Mureau M, Slijper FM, Nijman RJ, Van der Meulen JC, Verhulst FC, Slob AK. Physosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study. J Urol 1995;154:1902-1907
15. 15-Zoantz MR, Dean GE. Glandular hypospadias repair.. Urol Clin North Am 2002;29:291-298
16. 16-Bourdoumis A, Kapor S, Bhanot S. Megameatus intact prepuce revisited. Brit J Urol Int. 2012;84:1-5
17. 17-Docimo S. Subcutaneous frenulum flap (SCUFF) for iatrogenic or primary megameatus and reoperative hypospadias repair. Urology 2001;58(2)271-273
18. 18- Elbatarny AM, Sherif M, Shehata and Khaked A Ismail. Megameatus intact prepuce variety of hypospadias: tips for repair using the modified glanular approximation procedure. Ann Pediatr Surg 2011;7:82-87
19. 19- Sanal M, Karadag E, Konca Y, Kocabasoğlu U. Megameatus and intact prepuce (MIP) associated with meatal web: a case report. Acta Chir Ausriaca 2000;32:35-36
20. 20-Zaontz MR. The GAP (glans approximation procedure) for glanular/coronal hypospadias. J Urol 1989;141:359-361
21. 21-Snodgrass WT, Khavari R. Prior to circumcision does not complicate repair of hypospadias with an intact prepuce. J Urol 2006;176:296-8
22. 22-Manzoni G, Bracka A, Palminteri E, Marrocco G. Hypospadias surgery: when, what and by whom? BJU Int 2004;94:1188–1195