Congenital Megaprepuce: Literature Review and Surgical Correction

Abstract

Congenital megaprepuce (CMP) is a type of buried penis characterized by extensive redundancy and ballooning of the inner prepuce as a result of preputial stenosis and phimosis. The malformation typically presents with difficulty voiding, often requiring manual expression of stagnant urine. Multiple techniques have been reported for the treatment of CMP with varying levels of positive outcomes. The authors provide a review of published literature, in addition to describing the procedure and results of our surgical technique in three children aged eleven months, two years, and twelve years. The literature review was conducted using PubMed with keywords “congenital megaprepuce,” “megaprepuce,” “buried penis,” “CMP,” and “correction.” Results were then differentiated based on presence or absence of true congenital megaprepuce and the surgical correction thereof. Regarding our cases, all patients completed the procedure with excellent cosmesis and without complication. Our technique is shown to provide consistent, excellent esthetic outcome across a wide range of ages and may be replicated by others.

Byar's Flaps in the Management of Congenital Megaprepuce

“…[ 9 ] The actual etiology is hitherto unknown; however, it is attributed to the abnormal development of dartos. [ 5 ] Some authors also think that this condition is secondary to narrow preputial ring[ 10 11 ] while others contradict this view pleading that in some of the cases there is no true phimosis. [ 1 12 ]…”

“…[ 8 ] Many reconstructive techniques have been described including ventral v-plasties, z-plasties, cutaneous flaps and unfurling techniques. [ 5 15 ] However, consensus for the ideal management is still lacking. The goals of the surgeries are, removal of redundant inner prepuce as much as possible, covering of the shaft with outer skin to achieve best possible cosmetic results and finally fixing of the outer skin at the penopubic and the penoscrotal angles to impart normal appearance to the penis.…”

“…However, cosmetic appearance with the inner preputial covering of the penis is suboptimal. [ 5 ] Owing to the above, we conducted this study using outer preputial skin in the form of Byar's flaps to cover the penile shaft and analysed the results.…”

Differential diagnosis of congenital megaprepuce: therapeutic and prognostic relevance

“…It is characterized by redundant preputial mucosa along with a partial defect of the ventral preputial skin, which is thickened. This causes the penis to be fully covered, usually with no additional penile disorders (1) . Preputial ballooning as a result of urinary retention is the most common clinical presentation.…”

Diagnóstico diferencial del megaprepucio congénito: relevancia terapéutica y pronóstica

“…El megaprepucio congénito es una patología infrecuente caracterizada por una redundancia de mucosa prepucial acompañada de un defecto parcial de piel prepucial ventral, que se encuentra engrosada. Esta situación provoca una cobertura completa del pene, sin existir, en principio, otras alteraciones peneanas asociadas (1) . La presentación clínica más habitual es la balonización prepucial por retención urinaria.…”