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An arc incision surgical approach in congenital megaprepuce.

Lin HW, Zhang L, Geng HQ, Fang XL, Xu GF, Xu MS, Cai W - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, Xinhua Hospital, Shanghai 200092, China.

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Congenital megaprepuce (CMP) is considered as a congenital penile malformation, which includes phimosis and severe ballooning of the redundant inner prepuce, conferring the typical aspect of concealed penis, in which the whole attachment is hidden within subcutaneous tissue... Several approaches to concealed penis have been described in the literature, not all completely applicable to CMP, which is a condition that requires particular technique refinements to obtain the best functional and cosmetic results... This kind of discomfort and difficulty in voiding could be relieved by manual decompression of the swelling... No one had other malformation or associated pathology... Postoperatively, transient preputial edema occurred in every patient and disappeared spontaneously between 3 and 5 months... No significant immediate complications such as hemorrhage, urinary retention, urinary fistula, preputial necrosis, or local infection were found... However, a redundant inner prepuce over a prepuce ring, which is not retractable, probably plays an important role in leading to a ballooning of the foreskin while micturating... Although Summerton et al. thought that phimosis played no role in the pathogenesis of megaprepuce, it was almost impossible for us to evert the whole inner lay to expose the glans without releasing the stenosis ring of prepuce... Nevertheless, there were also some limitations in this series... The follow-ups were not long enough for us to make any decisive conclusion... Of course, long-term outcomes with patients’ satisfaction from a cosmetic and functional point of view will be needed to report confidently... Furthermore, this technique was not compared with other ones reported in the literatures... In conclusion, our technique of correcting CMP does not require advanced reconstructive skill, which closely resembles a standard circumcision... Considering that patients with CMP are relatively rare, we think multicenter corporations should be needed to cure the abnormality.

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(a) Major ballooning of inner prepuce during voiding. (b) An arc incision at the ventral prepuce. (c) Postoperative appearance. (d) Appearance after 8 weeks follow-up.
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Figure 1: (a) Major ballooning of inner prepuce during voiding. (b) An arc incision at the ventral prepuce. (c) Postoperative appearance. (d) Appearance after 8 weeks follow-up.

Mentions: During the past 9 years, 32 uncircumcised male children, aged from 10 months to 3 years, were referred to our institution. All of them were diagnosed with CMP, presenting with micturition troubles (dysuria and/or urinary retention) and/or urinary tract infections. When voiding, all the patients presented with major ballooning of the inner prepuce [Figure 1a]. After compression or spontaneous urine excretion, the swelling disappeared. General anesthesia was employed intraoperatively, and prophylactic antibiotic (cefaclor) was also given during urethral catheter drainage postoperatively. During the follow-up, secondary complications (such as redundant mucosa, secondary concealed penis, postsurgical penis curvature, urinary retention, and urinary infections) and cosmetic results were evaluated.


An arc incision surgical approach in congenital megaprepuce.

Lin HW, Zhang L, Geng HQ, Fang XL, Xu GF, Xu MS, Cai W - Chin. Med. J. (2015)

(a) Major ballooning of inner prepuce during voiding. (b) An arc incision at the ventral prepuce. (c) Postoperative appearance. (d) Appearance after 8 weeks follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836264&req=5

Figure 1: (a) Major ballooning of inner prepuce during voiding. (b) An arc incision at the ventral prepuce. (c) Postoperative appearance. (d) Appearance after 8 weeks follow-up.
Mentions: During the past 9 years, 32 uncircumcised male children, aged from 10 months to 3 years, were referred to our institution. All of them were diagnosed with CMP, presenting with micturition troubles (dysuria and/or urinary retention) and/or urinary tract infections. When voiding, all the patients presented with major ballooning of the inner prepuce [Figure 1a]. After compression or spontaneous urine excretion, the swelling disappeared. General anesthesia was employed intraoperatively, and prophylactic antibiotic (cefaclor) was also given during urethral catheter drainage postoperatively. During the follow-up, secondary complications (such as redundant mucosa, secondary concealed penis, postsurgical penis curvature, urinary retention, and urinary infections) and cosmetic results were evaluated.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, Xinhua Hospital, Shanghai 200092, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Congenital megaprepuce (CMP) is considered as a congenital penile malformation, which includes phimosis and severe ballooning of the redundant inner prepuce, conferring the typical aspect of concealed penis, in which the whole attachment is hidden within subcutaneous tissue... Several approaches to concealed penis have been described in the literature, not all completely applicable to CMP, which is a condition that requires particular technique refinements to obtain the best functional and cosmetic results... This kind of discomfort and difficulty in voiding could be relieved by manual decompression of the swelling... No one had other malformation or associated pathology... Postoperatively, transient preputial edema occurred in every patient and disappeared spontaneously between 3 and 5 months... No significant immediate complications such as hemorrhage, urinary retention, urinary fistula, preputial necrosis, or local infection were found... However, a redundant inner prepuce over a prepuce ring, which is not retractable, probably plays an important role in leading to a ballooning of the foreskin while micturating... Although Summerton et al. thought that phimosis played no role in the pathogenesis of megaprepuce, it was almost impossible for us to evert the whole inner lay to expose the glans without releasing the stenosis ring of prepuce... Nevertheless, there were also some limitations in this series... The follow-ups were not long enough for us to make any decisive conclusion... Of course, long-term outcomes with patients’ satisfaction from a cosmetic and functional point of view will be needed to report confidently... Furthermore, this technique was not compared with other ones reported in the literatures... In conclusion, our technique of correcting CMP does not require advanced reconstructive skill, which closely resembles a standard circumcision... Considering that patients with CMP are relatively rare, we think multicenter corporations should be needed to cure the abnormality.

Show MeSH