Megameatus intact prepuce: a systematic review of surgical techniques and long-term outcomes

Megameatus intact prepuce (MIP) presents with diverse phenotypes that complicate the management of this rare but complex hypospadias variant. Current data on optimal treatment methods and patient outcomes are sparse, unintegrated, and therefore challenging to implement clinically. A comprehensive systematic review of the existing literature on MIP was conducted according to PRISMA guidelines. Electronic databases including PubMed, Embase, and Scopus were searched for relevant articles published up to [2024]. Key aims were to assess the safety and efficacy of different surgical interventions, and synthesize corresponding outcomes reported in the literature. The search yielded 18 articles meeting the inclusion criteria, representing a total of 524 enrolled patients across multiple geographic regions. Diagnosis of MIP typically involves clinical examination, imaging studies, and urological evaluation. Surgical management options included preputial reconstruction, urethroplasty, and meatal advancement with glanuloplasty. Reported outcomes varied, with success rates ranging from [77.1-100%]. Long-term follow-up data on functional and cosmetic outcomes were limited. Megameatus intact prepuce presents diagnostic and management challenges due to low prevalence and variable presentation. This systematic review presents a current understanding of MIP diagnosis, surgical techniques, and patient outcomes. Future studies should assess the long-term functional outcomes of different surgical approaches, and investigate the underlying genetic and environmental factors contributing to the diverse clinical manifestations of MIP.