Tips and Tricks in the Management of Megameatus Intact Prepuce Variant of Hypospadias: A Review Article
Main Article Content
Abstract
Introduction: Hypospadias is congenital anomalies with various spectrum and variants, presenting with abnormal urethral meatus short of the native tip of the glans. megameatus intact prepuce is a rare variant of glanular hypospadias seen in about 3-6 % of hypospadias cases. The main features of megameatus intact prepuce are large urethral external meatus with deep with deeply grooved glans penis and the preputial skin is usually present and intact with no chordae. Seven named procedures for megameatus intact prepuce were discussed.
Methodology: We use the following search engines for out study where we found the following articles and reviews as follows in Scopus search, we found 26 articles, in AJOL we there were 7 articles and in PubMed Central Search we found 32 articles, then in Google scholar the search revealed 388 articles, 45 articles were reviewed and summarised and 7 established procedures were discussed.
Results: Seven named established procedures for megameatus intact prepuce variant of hypospadias were summarized and discussed and include Pyramid Procedure, Glanular Approximation Procedure, Tubularised Urethral Plate Urethroplasty, Tubularised Incised Urethral Plate Procedure, Mathieu Technique, Cutaneous advancement procedure and The Inframeatal Vascularised Flap Procedure.
DISCUSSION: The Surgical procedures for repair of megameatus intact prepuce is technically challenging not only for the surgeon but the anesthethiogist alike because the patients are paediatric with small organs, therefore appropriate instruments and proper timing of the surgical intervention is paramount. Duckett and Keating et al in their study identified the first challenge is to identify those patients who truly need surgical repair. In a study by Marc Cendron et al they found out that the features identified as important in the decision-making process were (1) meatal opening close to or below the coronal margin; (2) A deep glans cleft; (3) a wide, splayed-out glans; and (4) an abnormal urinary stream if witnessed. in a study by Duckett JW, Keating MA, Hatch DA et at and Austin Hill G, Wacksman J they reported a satisfactory outcome with the various described surgical procedures.
Conclusion: The tip and tricks of the surgical procedures of megameatus intact prepuce rare variant of hypospadias is a review article to aimed to improve on the surgical outcome including normal conical appearance of the glans, a urethral meatus of normal caliber, and a single, normal urinary stream with no symptoms and to minimise the complications such as urethrocutenous fistula as extracted from the expert’s vast experience and modifications of the existing techniques, in our study we summarised the experts seven established techniques and the modifications to achieve the desired objectives.
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References
2. Cendron M. The Megameatus, Intact Prepuce Variant of Hypospadias: Use of the Inframeatal Vascularized Flap for Surgical Correction. Front Pediatr. 2018 Mar 14;6:55. doi: 10.3389/fped.2018.00055. PMID: 29594086; PMCID: PMC5861193
3. Sanal M, Karadag E, Konca Y, Kocabasoglu U. Megameatus and intact prepuce (MIP) associated with meatal web: A case report. Acta Chir Austriaca 2000;32:35 6.
4. Bar Yosef Y, Binyamini J, Mullerad M, Matzkin H, Ben Chaim J. Megameatus intact prepuce hypospadias variant: Application of tubularized incised plate urethroplasty. Urology 2005;66:861 4
5. Bhat A, Bhat M, Bhat A, Singh V. Results of tubularized urethral plate urethroplasty in Megameatus Intact Prepuce. Indian J Urol 2017;33:315-8
6. Bourdoumis A, Kapoor S, Bhanot S. Megameatus intact prepuce revisited. Brit J Urol Int 2012. [Doi: 10.1002/BJUIw 2012 084 web].
7. Muhammad UM, Abdulkadir A, Sharfuddeen AM, Bashir Y (2019) Megameatus Intact Prepuce in a Two Years Old Boy in Katsina Northwestern Nigeria. Casereports | ReDelve: RD-CRP 10015.
8. Shouxing Duan, Xuewu Jiang, Xuan Zhang, Wenhui Ou, Maxian Fu, Kaihong Chen, Jianhong Li, Shuhua Ma, Megameatus intact prepuce treated with urethral plate-preserving surgery: a retrospective study of an unusual hypospadias variant, Transl Androl Urol 2019;8(6):583-590 | http://dx.doi.org/10.21037/tau.2019.10.12
9. Subramaniam R, Spinoit AF, Hoebeke P. Hypospadias repair: an overview of the actual techniques. Semin Plast Surg 2011; 25:206–212.
10. Elbatarny AM, Shehata SM, Ismail KA. Megameatus intact prepuce variety of hypospadias: Tips for repair using the modified glanular approximation procedure. Ann Pediatr Surg 2011;7:82 7.
11. Mureau, M. A., Slijper, F. M., Nijman, R. J., van der Meulen, J. C., Verhulst, F. C., & Slob, A. K. (1995). Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study. The Journal of urology, 154(5), 1902–1907.
12. Docimo SG. Subcutaneous frenulum flap (SCUFF) for iatrogenic or primary megameatus and reoperative hypospadias repair. Urology 2001; 58:271–273.
13. Duckett JW, Keating MA. Technical challenge of the megameatus intact prepuce hypospadias variant: the pyramid procedure. J Urol. 1989 Jun; 141(6):1407-9. doi: 10.1016/s0022-5347(17)41325-5. PMID: 2657110
14. Yoon JY, Cho DH, Hwang TK, Shin MS, Ahn JH (1995) 3 cases of 34. megameatus intact prepuce (MIP): pyramid procedure. Korean J Urol 36: 763-766.
15. Nonomura K, Kakizakia H, Shomoda N, et al: Surgieal repair of anterior hypospadias with fish-mouth megameatus and intact prepuce based on an anatomieal characteristies. Eur Uro!. 1998; 34:368-371
16. Van der Horst HJ, de Wall LL (2017) Hypospadias, all there is to know, 7. Review Eur J Pediatr 176: 435-441.
17. Gittes GK, Snyder CL, Murphy JP (1998) Glans approximation proce¬23. dure urethroplasty for the wide, deep meatus. Urology 52: 499-500.
18. Zaontz MR (1989) The GAP (Glans Approximation Procedure) for 24. glanular/coronal hypospadias. J Urol 141: 359-361.
19. Hatch DA, Maizels M, Zaontz MR, Firlit CF, Hypospadias hidden by a complete prepuce, Surg Gynecol Obstet (1989) 169:233-4.
20. Austin Hill G, Wacksman J, Lewis AG, Sheldon CA, The modified pyramid hypospadias procedure: repair of the megamemeatus and deep glanular groove variants, J Urol (1993) 150:1208-11.10.1016/S0022-5347(17) 35729-4
21. Duckett JW MAGPI (meatoplasty and glanuloplasty): A procedure for subcoronal hypospadias Urol Clin North Am 1981 8 513 9 7324318
22. Stephens FD Fortune DW. Pathogenesis of megalourethra. J Urol. (1993) 149:1512–6. 10.1016/S0022-5347(17)36431-58501800
23. Snodgrass WT Khavari R Prior circumcision does not complicate repair of hypospadias with an intact prepuce J Urol 2006 176 296 8 16753427 Front Pediatr Front Pediatr Front.
24. Bush NC Snodgrass W Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes. J Pediatr Urol. (2017) 13:625. e1–6. 10.1016/j.jpurol.2017.05.02029133164
25. Fahmy O Khairul-Asri MG Schwentner C Schubert T Stenzl A Zahran MH. Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol.
26. (2016) 70:293–8. 10.1016/j.eururo.2015.12.04726776935
27. Mizuno K Hayashi Y Kojima Y Tozawa K Sasaki S Kohri K Tubularized incised plate urethroplasty for proximal hypospadias Int J Urol 2002 9 88 90 12028297
28. Chen SC Yang SS Hsieh CH Chen YT Tubularized incised plate urethroplasty for proximal hypospadias BJU Int 2000 86 1050 3 11119100
29. Snodgrass W Yucel S Tubularized incised plate for mid shaft and proximal hypospadias repair JUrol 2007 177 698 702 17222659
30. Palmer LS Palmer JS Franco I Friedman SC Kolligian ME Gill B The ℌlong Snodgrassℍ: Applying the tubularized incised plate urethroplasty to penoscrotal hypospadias in 1-stage or 2-stage repairs J Uroi 2002 168 1748 50 12352351
31. Marte A Di Iorio G De Pasquale M Cotrufo AM Di Meglio D Functional evaluation of tubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry BJU Int 2001 87 540 3 11298053
32. Snodgrass W Koyle M Manzoni G Hurwitz R Caldamone A Ehrlich R Tubularized incised plate hypospadias repair for proximal hypospadias J Urol 1998 159 2129 31 9598557
33. Duan S, Jiang X, Zhang X, Ou W, Fu M, Chen K, Li J, Ma S. Megameatus intact prepuce treated with urethral plate-preserving surgery: a retrospective study of an unusual hypospadias variant. Transl Androl Urol 2019;8(6):583- 590. doi: 10.21037/tau.2019.10.12
34. Mao Y, Tang Y, Chen S, et al. Recognition and management of megameatus with intact prepuce (MIP): a variant of hypospadias. Chin J Pediatr Surg 2011;32:834-6.
35. Professor Ahmed T. Hadidi. Hypospadias Surgery. International Workshopon Hypospadias Surgery, Medical University Vienna , 2006;6.
36. Amir F. Azmy, Megameatus Intact Prepuce Variant, chapter 13.2 page 135-136, A. T. Hadidi et al. (eds.), Hypospadias Surgery © Springer-Verlag Berlin Heidelberg; 2004.
37. Sanal M, Karadag E, Konca Y, Kocabasoglu U. Megameatus and intact prepuce (MIP) associated with meatal web: A case report. Acta Chir Austriaca. 2000;32:35–36. DOI: 10.1007/BF02949214
38. Yuval Bar-Yosef, Joseph Binyamini, Michael Mullerad, Haim Matzkin, Jacob Ben-Chaim, Megameatus intact prepuce hypospadias variant: Application of tubularized incised plate urethroplasty, Urology, Volume 66, Issue 4, October 2005, Pages 864https://doi.org/10.1016/j.urology.2005.04.070
39. Fahmy MAB, Shenawy AAE, Altramsy A, et al. Penile Median Raphe Anomalies as an Indicator of Megameatus Intact Prepuce Anomaly in Children Undergoing Routine Circumcision. Urology 2018;121:164-7
40. Hardwicke JT, Bechar JA, Hodson J, et al. Fistula after single-stage primary hypospadias repair - A systematic review of the literature. J Plast Reconstr Aesthet Surg 2015;68:1647-55.
41. Chrzan R, Dik P, Klijn AJ, et al. Quality assessment of hypospadias repair with emphasis on techniques used and experience of pediatric urologic surgeons. Urology 2007;70:148-52.
42. Bar-Yosef Y, Binyamini J, Mullerad M, et al. Megameatus intact prepuce hypospadias variant: application of tubularized incised plate urethroplasty. Urology 2005;66:861-7
43. Faasse MA, Dray EV, Cheng EY. Repair of megameatus: a modified approach. J Pediatr Urol 2015;11:100-1.
44. Steven GDocimo, Subcutaneous frenulum flap (SCUFF) for iatrogenic or primary megameatus and reoperative hypospadias repair, Urology. 2001;58(2):271-273. Available:https://doi.org/10.1016/S0090-4295(01)01181-5