Pseudo-iatrogenic hypospadias: the megameatus intact-prepuce hypospadias variant

This article presents the authors' experience with 21 patients with the megameatus variant of hypospadias who were treated during an 8-year period. In nine of the cases, the parents were convinced that the defect was a complication of circumcision, and the patients were examined in consultations in preparation for litigation. Seven of those nine patients had been previously examined by either a plastic surgeon or a urologist, who failed to recognize this variant. The typical appearance of the defect and how to differentiate this congenital deformity from true iatrogenic hypospadias are described. The features of the megameatus intact-prepuce variant of hypospadias include a wide spatulated glans, a deep groove, a large wide patulous meatus at the subglanular groove, an intact prepuce before circumcision, no evidence of glanular scarring, and no history of bleeding at the time of circumcision.