Megameatus intact prepuce variety of hypospadias: tips for repair using the modified glanular approximation procedure

Abstract

Background/purpose Megameatus and intact prepuce (MIP) is an unusual, anterior hypospadias variant. Cosmetic remodeling is usually carried out to avoid disturbing the child’s psychological state. Several approaches are used for MIP repair. The purpose of this study was to present a single institution’s experience with the modified glanular approximation procedure (GAP) in the treatment of the MIP variant of hypospadias and the tips needed to obtain the best outcome.
Patients and methods Seventeen patients with MIP were repaired between May 2004 and May 2009 by the modified GAP technique. The technique was used to achieve a conical glans with a vertical slit, tip-cited meatus, and a straight urine stream. Patient/parent satisfaction was assessed by a subjective score that ranged between 0 and 3 and complications were reported.
Results All patients were repaired using the modified GAP technique. The age of the patients ranged from 6 months to 28 years. Four patients were circumcised with a history of intact prepuce. An intermediate layer was added in seven patients. Excision of a part of the redundant urethral plate was carried out in six cases. Disruption of the repair occurred in one patient as a result of wound infection. Excellent cosmetic results were achieved in 14 patients (10 with a subjective score of 3 and four with a subjective score of 2). Two patients expressed an acceptable score of 1 and one patient was dissatisfied with a subjective score of 0.
Conclusion Good cosmetic results, such as achievement of a straight urine stream and patient satisfaction, can be achieved using the modified GAP procedure. The steps should be tailored to individual cases.

Keywords: hypospadias, megameatus, modified glanular approximation procedure