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Megameatus intact prepuce variant reconstruction: Long-term outcomes and comparison to post-circumcision hypospadias repair

Herzberg, Haim ; Ben-David, Reuben ; Mendelson, Tomer ; Dubi-Sobol, Adit ; Bashi, Tomer ; Savin, Ziv ; Ben-Chaim, Jacob ; Bar-Yosef, Yuval

Journal of pediatric urology, 2024-02, Vol.20 (1), p.38.e1-38.e6 [Periódico revisado por pares]

England: Elsevier Ltd

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  • Título:
    Megameatus intact prepuce variant reconstruction: Long-term outcomes and comparison to post-circumcision hypospadias repair
  • Autor: Herzberg, Haim ; Ben-David, Reuben ; Mendelson, Tomer ; Dubi-Sobol, Adit ; Bashi, Tomer ; Savin, Ziv ; Ben-Chaim, Jacob ; Bar-Yosef, Yuval
  • Assuntos: Child ; Circumcision ; Circumcision, Male - adverse effects ; Circumcision, Male - methods ; Humans ; Hypospadias ; Hypospadias - diagnosis ; Hypospadias - surgery ; Hypospadias repair complications ; Hypospadias repair outcome ; Infant ; Infant, Newborn ; Male ; Megameatus intact prepuce ; Retrospective Studies ; Treatment Outcome ; Urethra - surgery ; Urologic Surgical Procedures, Male - adverse effects ; Urologic Surgical Procedures, Male - methods
  • É parte de: Journal of pediatric urology, 2024-02, Vol.20 (1), p.38.e1-38.e6
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
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  • Descrição: Megameatus intact prepuce (MIP) variant is considered a surgical challenge with associated high complication rates. It is usually diagnosed and corrected only after neonatal circumcision, which is discouraged in non-MIP hypospadias. In order to determine whether the features of the MIP variant or the performance of a secondary reconstruction following circumcision comprise the cause of higher complication rates, we now compared the results of post-circumcision MIP hypospadias repair to the results of children who underwent repair of non-MIP hypospadias following neonatal circumcision. Reoperation rates of children operated for hypospadias repair following neonatal circumcision between 1999 and 2020 were compared between those with MIP and those with classic non-MIP hypospadias. In total, 139 patients who had undergone neonatal circumcision underwent surgical reconstruction at a mean age of 13 months. Sixty-nine had classic hypospadias and 70 had the MIP variant. The median follow-up was 10 years (interquartile range 6,13). The classic group had a higher rate of meatal location below the corona compared to the MIP variant group (53 % vs. 28 %, respectively, p = 0.002). The reoperation rate was comparable for the two groups (32 % vs. 27 %, p = 0.58, Table). Univariate analysis for the MIP hypospadias group showed no association between reoperation and the initial patient characteristics, while a higher probability of reoperation was demonstrated in the presence of ventral curvature (odds ratio 3.5, p = 0.02), and a higher grade of hypospadias (odds ratio 3.3, p = 0.03 for meatal location lower than the coronal sulcus) in the non-MIP group. The limitations of our work include its retrospective design wherein the patients’ characteristics, including classification as MIP vs. non-MIP, are derived from medical records. More patients in the non-MIP group were documented to have penile curvature. The non-MIP group was composed of more patients with meatal location under the coronal sulcus, a factor which may increase the rates for reoperation in that group. Still, with the comparison of the largest reported cohort of circumcised MIP with circumcised non-MIP patients together with an extended follow-up period, we believe that we present strong evidence of the possible role of previous circumcision in the surgical challenge of reconstructing MIP hypospadias. Reoperation rates in MIP hypospadias are high but similar to those of classic hypospadias, both following circumcision, suggesting that circumcision, rather than the unique features of the variant, is the cause for complications.Summary tableCharacteristics and results of MIP vs. hypospadias, both after circumcisionSummary tableMIP (n = 70)Hypospadias (n = 69)pAge, months (IQR)11.5 (8.2,15)14 (9,22)0.042Hypospadias degree, n0.015Glanular22 (31 %)10 (15 %)Coronal29 (41 %)22 (32 %)Subcoronal13 (19 %)22 (32 %)Distal shaft5 (8 %)13 (19 %)Mid shaft1 (1 %)1 (1 %)Proximal shaft01 (1 %)Curvature, n15 (21 %)24 (35 %)0.09Torsion, n3 (4 %)2 (3 %)0.66Repair technique, n<0.001TIP40 (57 %)56 (81 %)MAPGI16 (23 %)11 (16 %)Thiesrch-Duplay8 (11 %)0Mathieu2 (3 %)0Meatoplasty02 (3 %)GAP4 (6 %)0Reoperation, n19 (27 %)22 (32 %)0.58Reoperation etiology, n0.39Fistula11 (16 %)16 (23 %)Meatal stenosis5 (7 %)5 (7 %)Redundant skin3 (4 %)1 (1 %)
  • Editor: England: Elsevier Ltd
  • Idioma: Inglês
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