A Review of Surgical Management Options of Megameatus Intact Prepuce

Introduction: Hypospadias is a continuum of different variants, and megameatus intact prepuce (MIP) is an uncommon form of glandular hypospadias seen in around 3-6% of hypospadias. Surgical options in the management of megameatus intact prepuce depends on multiple scenarios and is multifactorial, hence the different surgical options with different outcomes. The aim of this article is to review the surgical management options of these rare variant of hypospadias called megameatus intact prepuce.

Materials and Methods: We look for information on the following platformsGoogle Scholar, PubMed Central (PMC), PubMed, AJOL and EMBASE for articles on Megameatus intact prepuce, and the last search was on 14th May, 2021, using the keywords surgical management options of megameatus intact prepuce and the relevant articles were reviewed to extract the surgical options of managing megameatus intact prepuce variant of hypospadias from the experts.

Results: The surgical management of MIP is aimed at restoring function and cosmesis, and several surgical techniques, including the glanular approximation procedure (GAP), the pyramid procedure, the cutaneous advancement procedure, the tubularised incised plate (TIP), the tubularised Urethral Plate Urethroplasty (TUPU), the Mathieu technique, and the subcutaneous frenulum flap with many modifications, have been described.

Discussion: MIP is rare and was first described by Juskiewenski and co in 1983, several researchers have reported on various surgical treatment options with varying results,, Elbatarny et al observed GAP in seventeen patients with MIP over a five-year span in 2011, with an excellent outcome in 14 patients and a subjective score of 1 in two patients, with one patient expressing disappointment with the outcome. M. Sanal et al. identified an excellent outcome in seven cases with GAP.

Conclusion: The surgical management options for megameatus intact prepuce are many, with varying modifications and results, necessitating a urologist's knowledge of as many procedures as possible in order to achieve a desired aim in treating this group of patients with an unusual anomaly.