Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce.

Shou Xing Duan,Wenhui Ou,Maxian Fu,Kaihong Chen,Shu Hua Ma,Lian Zheng,Xuan Zhang,Jianhong Li,Xuewu Jiang

doi:10.3389/fped.2020.00128

Abstract

Purpose: To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP).Materials and Methods: A retrospective analysis was performed in 27 MIP children, 13 of whom underwent tubularized incised plate urethroplasty (TIP procedure), 7 underwent the Duplay procedure, 5 underwent the Mathieu procedure, 1 underwent meatal advancement and glanuloplasty (MAGPI procedure), and 1 underwent the glans approximation procedure (GAP). The patients were followed for 6–36 months to evaluate the surgical outcomes by the Pediatric Penile Perception Score (PPPS).Results: A total of 27 patients with a mean age of 8.12 ± 3.0 years were enrolled in this study, and 25 cases (25/27, 92.6%) were accidentally discovered during the first visit for phimosis. The patients had a formed urethra of 0.5 to 1.5 cm. Complications occurred in 4 of the 27 patients (14.81%): 2 patients with urethral fistula and 2 patients with meatal stenosis. One patient had a case of self-healed urethral fistula, and the remaining 3 patients underwent reoperation. The post-operative effect was satisfactory in all patients, and the urinary flow and stream during urination were normal. The overall average PPPS score of non-operative surgeons and parents was satisfactory. There were no significant differences in meatus appearance, glans appearance, skin appearance, and general appearance PPPS score among the Mathieu, TIP, and Duplay surgical procedures.Conclusions: MIP clinical manifestations are concealed and usually noted when circumcision is attempted. The suitable procedure for each patient should be tailored according to the anatomic features, and several techniques can be used with good functional and cosmetic results.

Highlights

Megameatus intact prepuce (MIP) is a unique variant of hypospadias and is a clinically rare condition, with an incidence of ∼1/10,000, accounting for 1–3% of the incidence of hypospadias [1, 2]
Due to the anatomical particularity of MIP, it is necessary for clinicians to design a suitable surgical method taking into account the development of the glans, the width of the urethral plate, the depth of the urethral groove, and the shape and position of the urethral opening, to achieve good therapeutic effects [3, 6, 7]
One-way analyses of variance (ANOVA) was used to compare the statistical differences of these Penile Perception Score (PPPS) score among the Mathieu, TIP, and Duplay surgical procedures, and the results showed no significant differences (P > 0.05) (Table 3)

Summary

Introduction

Megameatus intact prepuce (MIP) is a unique variant of hypospadias and is a clinically rare condition, with an incidence of ∼1/10,000, accounting for 1–3% of the incidence of hypospadias [1, 2]. An increasing number of articles have focused on this rare hypospadias variant, and the awareness of and surgical procedures for MIP continue to evolve [4, 5]. Due to the anatomical particularity of MIP, it is necessary for clinicians to design a suitable surgical method taking into account the development of the glans, the width of the urethral plate, the depth of the urethral groove, and the shape and position of the urethral opening, to achieve good therapeutic effects [3, 6, 7]. We reviewed the clinical data of 27 MIP children from our hospital to better characterize the diagnosis of and treatment methods for MIP

Methods

Results

Conclusion