Megameatus Intact Prepuce: Families May Find it Diffucult to Give A Consent to Surgery in Non-Severe Cases, and the Surgery Can be More Difficult in Late Presentation

Abstract

We presented rare 8 megameatus intact prepuce (MIP) hypospadias variants and perspectives of families and patients regarding the surgery and our outcomes. Material and Methods: The 8 glanular MIP cases were admitted to our clinic between 2020-2023, aged between 3 to 17. The 6 cases were presented for circumcision, 2 were admitted with self suspicions. A 17-year-old was admitted for abnormal meatal appearance, considering self-awareness in advanced age; an 11-year-old family had suspected an anomaly after circumcision. Meatuses were glanular in 5, coronal in two, and distal penile in one. Mathieu flap techniques for uncircumcised and meatal advancement and glanuloplasty (MAGPI) for circumcised cases were preferred. Results: In four cases, the family declined to have the operation, due to a perceived lack of abnormalities. Two uncircumcised MIP cases were successfully treated using Mathieu flap techniques. The one circumcised glanular MIP was repaired by the MAGPI technique, resulting in late fistula formation. The 17-year-old case was treated with Matheus techniques using prepuce flaps, but ended up with a late fistula formation due to unpreventable erection episodes. Conclusion: MIP ıs a rare hypospadias variant and ıs commonly concealed by the foreskin causing difficulty in detection, delayed diagnosis, sometimes even after circumcision, and may cause families to reject surgical correction due to a perceived lack of abnormalities. However, as it is shown in our series, a lack of preputial tissue or advanced age may negatively impact the operation's success. Families should be informed about the surgical difficulty in late presentation. The Mathieu techniques can be safely applied in non-circumcised MIP cases.