Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Glanular Approximation Procedure in Megameatus Intact Prepuce: A Case Series
Megameatus Intakt Prepisyumda Glanuler Yaklaştırma Prosedürü: Olgu Serisi
Volkan Sarper ERİKCİa, Ali SAYANb, Mustafa Onur ÖZTANc, Tunç ÖZDEMİRa, Gökhan KÖYLÜOĞLUc
aDepartment of Pediatric Surgery, University of Health Sciences Tepecik Training and Research Hospital,
bDepartment of Pediatric Surgery, Tepecik Training and Research Hospital,
cDepartment of Pediatric Surgery, İzmir Katip Çelebi University Tepecik Training and Research Hospital, İzmir, TURKEY
J Reconstr Urol. 2019;9(3):95-9
doi: 10.5336/urology.2019-71404
Article Language: EN
Full Text
ABSTRACT
 Objective: The megameatus intact prepuce (MIP) is a rare type of hypospadias which is usually diagnosed during circumcision. In this study, it is aimed to present our experience with glanular approximation procedure (GAP) in the management of MIP. Material and Methods: A retrospective study of 13 patients with MIP variant of hypospadias who were repaired between September 2017 and April 2019 using GAP technique was performed. The total number of hypospadias cases during the study period was 85 and MIP cases constituted 15.3% of these patients. The surgical aims in GAP are to achieve a conical glans containing vertical slit, tip-cited meatus and a normal projectile urine flow. Results: The age range of the patients was between 18 months and 7 years. The locations of urethral meatus were glanular in 8 and coronal in 5. In all the cases, the neourethra was constructed using 7/0 polydioxanone (PDS)® in a subcuticular and uninterrupted fashion. Except for 5 patients with coronal meatus that an intermediate layer from nearby dartos fascia was interposed to support urethroplasty suture line, no intermediate layer was transposed between the tissue layers with two overlying suture lines. Good cosmetic result was obtained in all patients with a normal appearing conical glans penis. One patient developed urethrocutaneous fistula requiring surgical closure. Conclusion: The MIP is a simple form of hypospadias which sometimes may produce problems to surgeons. The GAP procedure is a simple technique with good cosmetic results producing patient satisfaction. Except for more severe MIP cases, GAP technique is useful in hypospadiac patients with MIP especially having glanular and coronal meatus.

Keywords: Hypospadias; megameatus intact prepuce; glanular approximation technique
ÖZET
 Amaç: Megameatus intakt pepisyum (MİP) nadir bir hipospadias çeşididir ve sıklıkla sünnet sırasında saptanır. Bu çalışmada MİP'li olgulardaki glanuler yaklaştırma tekniğine (GYT) ait tecrübemiz sunulmuştur. Gereç ve Yöntemler: Eylül 2017 ile Nisan 2019 tarihleri arasında MİP'li 13 olgu GYT ile tedavi edilmişlerdir. Çalışma dönemindeki toplam hipospadias olgu sayısı 85 olup bunların %15,3'ünü MİP olguları teşkil etmektedir. Sunulan teknikteki amaç koni şekilli glans, uca yerleşik üretral meatus ve normal projektilitesi olan idrar akımı elde etmektir. Bulgular: Olguların yaş aralığı 18 ay ile 7 yıl arasında değişmektedir. Üretral meatus yerleşimi 8 olguda glanuler, 5 olguda da koronal düzeydedir. Tüm olgularda neoüretra 7/0 polidioksanone (PDS)® kullanılarak subkütiküler devamlı dikiş tekniği ile oluşturulmuştur. Koronal düzeyde meatusu buluna 5 olgu dışında hiçbir olguya orijinal GYT'deki gibi doku tabakaları arasına herhangi bir ara tabaka konulmamıştır ve iki sütür hattı üst üste gelmektedir. Tüm olgularda konik şekilli glans penisin elde edildiği tatminkar bir kozmetik sonuç alınmıştır. Bir olguda üretral fistül gelişmiş ve fistül onarımı uygulanmıştır. Sonuç: MİP hipospadiasın basit bir şekli olup bazen cerrahlar için sorun teşkil edebilmektedir. GYT iyi kozmetik sonuçları olan ve hasta memnuniyetini sağlayan basit bir tekniktir. Ağır MİP olguları dışında özellikle glanuler ve koronal düzeyde üretral meatusu olan MİP olgularında GYT yararlıdır.

Anahtar Kelimeler: Hipospadias; megameatus intakt pepisyum; glanuler yaklaştırma tekniği
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