Abstract
Surgical treatment of congenital megaprepuce is challenging and controversial. We report our 10-year experience treating patients with this deformity using a standardized procedure that has similarities to a technique reported by Smeulders et al. (1). Our postoperative complications and mid-term follow-up cosmetic appearance of the genitalia after reconstruction are reviewed. Fifteen patients operated on between 2005 and 2015 were evaluated. Age at surgical repair ranged from 3 to 20 months (mean 9). Treatment included unfolding the preputial sac via a ventral approach, excision of redundant inner preputial skin, and ventral skin coverage with the outer preputial layer. Twelve patients presented associated partial scrotal engulfment, which was simultaneously treated. Mean follow-up was 4.6 years (range 2-7 years). Short-term complications occurred in three patients: scrotal hematoma in one patient and small skin dehiscence at the penoscrotal junction in two patients. Skin disruption healed by secondary epithelial ingrowth. All cases resulted in a satisfactory genital cosmetic outcome. There were no late complications. All patients preserved normal external genitalia appearance. Our experience is in agreement with reports of other authors; suggesting that excision of the inner preputial layer and using the external one for penile coverage provide good and durable mid-term esthetic results in megaprepuce reconstruction.
Highlights
Megaprepuce is a rare development abnormality characterized by marked ballooning of the foreskin covering a normal-sized penis
We retrospectively report the outcome and mid-term follow-up in consecutive patients treated with a standardized surgical procedure excising the inner preputial layer and utilizing the outer one to cover the penile shaft
Complications after surgery included a scrotal hematoma in one patient and in two cases skin dehiscence at the penoscrotal junction
Summary
Megaprepuce is a rare development abnormality characterized by marked ballooning of the foreskin covering a normal-sized penis. In 1994, O’Brien et al [2] reported this condition and named it congenital megaprepuce. Since its introduction several surgical techniques have been described for the treatment of this deformity [2,3,4,5]. We retrospectively report the outcome and mid-term follow-up in consecutive patients treated with a standardized surgical procedure excising the inner preputial layer and utilizing the outer one to cover the penile shaft. Several specific points of the technique are briefly analyzed
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