Results of tubularized urethral plate urethroplasty in Megameatus Intact Prepuce

The megameatus variant of anterior hypospadias with an intact complete foreskin occurs in approximately 1%-3% of hypospadias. Hence, the objective of the study was to evaluate the results of tubularized urethral plate urethroplasty (TUPU) in megameatus intact prepuce (MIP).

A retrospective study (June 1996-June 2015) of MIP from our hypospadias registry was conducted. All patients with megameatus, either with an intact prepuce or with one previously removed, were included in the study. Case sheets of clinical records, investigations, clinical photographs, and videos were reviewed. Patients were classified into, glanular, coronal, subcoronal, and distal penile. TUPU were done. Patients were called for follow-up at 1, 3, 6, and 12 months postoperatively, and then yearly for the assessment of the cosmetic appearance and fistula, meatal stenosis, or other complications.

Of 1026 patients with hypospadias, we identified 13 cases of megameatus variant of hypospadias; three of the 13 had been circumcized previously. Glanular approximation was done for the one patients of the glanular variant, and another had frenuloplasty. These two patients were excluded from the study. Incision in the inner preputial skin was closed in 10 patients to have an intact prepuce. Follow-up period varied from 6 months to 4 years (median follow-up 2½ years). None of the patients developed complications such as fistula, meatal stenosis, and/or wound dehiscence.

Surgical correction of MIP in the era of increased cosmetic awareness is justified. Excellent results are obtained with TUPU and along with spongioplasty and frenuloplasty because of availability of wide urethral plate and well-developed spongiosum in these patients. TUPU should be the preferred procedure in cases of MIP.