Penile Median Raphe Anomalies as an Indicator of Megameatus Intact Prepuce Anomaly in Children Undergoing Routine

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Mohamed A Baky Fahmy1, Alaa A El Shenawy2, Aymen Altramsy3

  • 1AL-Azhar University, Faculty of Medicine, Pediatric Surgery Department, Cairo, Egypt.

Urology
|August 11, 2018
PubMed
Abstract

Insights

Median raphe anomalies, such as deviation and hyperpigmentation, are key indicators for detecting megameatus with an intact prepuce (MIP) in infants. Early diagnosis of MIP is crucial for timely management.

Area of Science:

  • Pediatric Urology
  • Congenital Genitourinary Anomalies

Background:

  • Megameatus with an intact prepuce (MIP) is a congenital condition often undetected until later childhood.
  • Diagnosis typically occurs incidentally during attempts at preputial retraction or neonatal circumcision.

Purpose of the Study:

  • To identify indicators for the early diagnosis of megameatus with an intact prepuce (MIP).
  • To investigate the association between median raphe (MR) anomalies and MIP.
  • To establish the diagnostic value of MR anomalies for MIP detection.

Main Methods:

  • Prospective examination of 12,518 neonates and infants undergoing ritual circumcision.
  • Detailed genitourinary anomaly screening, focusing on MIP and associated median raphe (MR) anomalies.
  • Statistical analysis of MR anomalies' sensitivity, specificity, and predictive values in MIP cases.

Main Results:

  • The incidence of MIP was found to be 0.12% in the studied cohort.
  • Eighty percent (12/15) of MIP cases exhibited associated MR anomalies, including raphe deviation, hyperpigmentation, prominence, and bifurcation.
  • Associated findings included redundant prepuce (3 cases) and paraphimosis (1 case); no other significant genitourinary anomalies were noted.

Conclusions:

  • Median raphe anomalies, particularly deviation and hyperpigmented prominent raphe, serve as significant indicators for the presence of undiagnosed MIP.
  • While redundant prepuce can occur, it is not a consistent finding in MIP.
  • Routine examination for MR anomalies during neonatal circumcision can aid in the early detection of MIP.

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