Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
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
Megameatus İntakt Prepisyum: Aileler Komplike Olmayan Olgularda Cerrahiye Onay Vermekte Zorlanabilirken Gecikmiş Vakalarda Cerrahi Zor Olabilir
Timuçin ŞİPALa , Ferhat Yakup SUÇEKENb
aDepartment of Urology, Kırıkkale University Faculty of Medicine, Kırıkkale, Türkiye
bClinic of Urology, Ümraniye Training and Research Hospital, İstanbul, Türkiye
J Reconstr Urol. 2023;13(3):109-14
doi: 10.5336/urology.2023-99438
Article Language: EN
Full Text
ABSTRACT
 Objective: 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.

Keywords: Megameatus intact prepuce; family perspective; hypospadias; Mathieu technique
ÖZET
 Amaç: Biz bu çalışmada, nadir görülen 8 megameatus intakt prepisyum (MİP) hipospadias varyant vakasını, ailelerin ve hastaların cerrahiye bakış açısını ve sonuçlarımızı sunmak istedik. Gereç ve Yöntemler: Sekiz MİP vakası kliniğimize 2020-2023 yılları arasında başvurdu, yaşları 3-17 arasında değişmekte idi. Altı vaka sünnet talebi ile başvurdu, 2 vaka kendi şüpheleri üzerine başvurdu; 17 yaşında olan abnormal meatus görünüşü ile ki ileri yaşta kendi farkındalığını düşündürüyor,11 yaşındaki vakanın ise ailesi sünnet sonrası anormallikten şüphelenmişti. Üretral açılım 5 vakada glanular, 2 vakada koronal ve bir vakada distal penildi. Sünnetsiz vakalarda Mathieu flap tekniği, sünnetli vakalarda ise meatal advancement and glanuloplasty (MAGPI) tekniği kullanıldı Bulgular: Dört vakada aile cerrahi önerisini kabul etmedi, sebep olarak görünür ve fonksiyonel bir anomali olduğunu düşünmediğini belirtti. İki sünnet olmamış vaka, Mathieu flap yöntemi ile başarılı bir şekilde tedavi edildi. MAGPI yöntemi ile onarılan bir glanular MIP vakasında geç fistül gelişti. 17 yaşındaki Mathieu ve prepusyal flap yöntemi ile onarılan olgu, önlenemez ereksiyonlar nedeni ile geç dönem fistül oluştu. Sonuç: MİP nadiren görülen bir hipospadias varyantı olup, genellikle sünnet derisi ile gizlenmiştir. Bu durum tanıda gecikmeye, sünnet sonrası tanı konulmasına veya görünümün ve işlevin normal olduğu düşüncesi ile ailelerin cerrahi önerisini kabul etmemesine neden olabilir. Bununla birlikte serimizde de gösterildiği gibi sünnet derisinin olmayışı ve ilerlemiş yaş cerrahi başarısını negatif etkileyen faktörler olabilmektedir. Aileler geciken başvurulardaki düşük cerrahi başarısı hakkında mutlaka bilgilendirilmelidir. Sünnetli olmayan vakalarda Mathieu tekniği güvenli bir şekilde uygulanabilmektedir.

Anahtar Kelimeler: Megametaus intakt prepisyum; aile bakış açısı; hipospadias; Mathieu tekniği
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