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Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Byar's flaps in the management of congenital megaprepuce
Omar Alsamahy1, Dalia Gad1, Doaa Othman1
1Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt.
Insights
Congenital megaprepuce (CMP) management using Byar's flaps offers excellent cosmetic and functional outcomes. This surgical technique effectively addresses symptoms like infections and urinary issues, improving patient and parental satisfaction.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Congenital Abnormalities
Background:
- Congenital megaprepuce (CMP) requires early management to prevent recurrent urinary tract infections and address parental concerns.
- Current surgical methods for CMP often result in suboptimal cosmetic appearance due to the use of inner preputial skin.
- This study investigates an alternative approach using outer preputial skin for improved cosmetic outcomes.
Purpose of the Study:
- To evaluate the functional and cosmetic results of using Byar's flaps with outer preputial skin for congenital megaprepuce (CMP) repair.
- To assess parental satisfaction with the cosmetic outcomes of the Byar's flap technique in CMP management.
Main Methods:
- A prospective study involving 19 pediatric patients with CMP undergoing surgery by a single surgeon.
- The Byar's flap technique, utilizing outer preputial skin, was employed for penile shaft coverage.
- Post-operative assessments included functional and cosmetic evaluations at multiple time points, with subjective parental satisfaction scoring.
Main Results:
- Nineteen patients with CMP, with a mean age of 6.3 months, were included.
- Pre-operative symptoms included buried penis, ballooning, urinary infections, thin urine stream, and dysuria.
- The Byar's flap technique demonstrated satisfactory cosmetic appearance in all patients, with only one case of meatal stenosis requiring management.
Conclusions:
- Congenital megaprepuce (CMP) is an identifiable condition necessitating early surgical intervention to prevent complications.
- The Byar's flap technique provides highly favorable functional and cosmetic results for CMP management.
- This approach offers a superior cosmetic outcome compared to traditional methods using inner preputial skin.
Introduction:
Early management of congenital megaprepuce (CMP) is necessary to address recurrent urinary tract infections and parental concerns. Different procedures, mostly using the inner preputial skin to cover the phallus, have been described. However, cosmetic appearance with the inner preputial covering of the penis is suboptimal. Owing to this, we conducted this study using outer preputial skin in the form of Byar's flaps to cover the penile shaft and analysed the results.
Patients And Methods:
This prospective study included 19 patients with CMP operated by a single surgeon using the Byar's flap technique. Following surgery patients were assessed on the 4th post-operative day, at 3 months and 1-year post-operative for cosmetic and functional outcomes. Parental satisfaction about cosmetic results was evaluated using a subjective score. Data were collected and analysed.
Results:
Nineteen patients with CMP were studied with a mean age of 6.3 months. Nineteen patients (100%) patients presented with buried penis and preputial ballooning, malodorous infected urine in 15 (78.9%) patients, thin stream of urine in 17 (89.4%) and dysuria in 12 (63%) patients. One of the patients had associated glanular hypospadias and the other two had isolated chordee. There were no significant complications except for one patient who developed meatal stenosis which was later managed by a meatoplasty. All patients had satisfactory cosmetic appearance.
Conclusion:
CMP is an uncommon but easily identifiable condition. Early surgical correction is recommended to prevent complications. Byar's flap technique yields very good functional and cosmetic results in the management of CMP.
