Congenital Megaprepuce: A New Alternative Technique for
Surgical Correction
Jovelino Q. Leao, Luiz G. Freitas Filho, Adriano L. Gomes, Antonio C. Heinsich, Jose Carnevale
Division of Urology (JQL, LGFF, ALG, ACH, JC), Darcy Vargas Children’s Hospital, Sao Paulo, and Division of Pediatric Surgery (LGFF), Federal University of Sao Paulo, Sao Paulo, Brazil
ABSTRACT
Objective:To present a new alternative technique for surgical treatment of congenital megaprepuce.
Materials and Methods: )URP$SULOWR$SULO¿YHSDWLHQWVDJHGWR\HDUVZHUHWUHDWHGXVLQJWKHQHZWHFKQLTXH 7KHWHFKQLTXHLVGHVFULEHGDQGLOOXVWUDWHG,WGLIIHUVIURPRWKHUWHFKQLTXHVLQWKDWLWWDNHVLQWRFRQVLGHUDWLRQWKHFRQVWDQW EDOORRQLQJRIWKHIRUHVNLQZKLFKJLYHVWRWKHH[WHUQDOJHQLWDOLDWKHDVSHFWRIDSHQRVFURWDOWUDQVSRVLWLRQ&RVPHWLFDQG IXQFWLRQDOVXFFHVVZHUHDOVRDVVHVVHGE\DFDVHUHYLHZ
Results:$IWHUDIROORZXSRIWR\HDUVDOOSDWLHQWVKDYHQRUPDOYRLGLQJDQGDVDWLVIDFWRU\FRVPHWLFDVSHFW Conclusion:7KLVQHZWHFKQLTXHFRXOGEHDXVHIXODOWHUQDWLYHLQWUHDWPHQWRIWKHFRQJHQLWDOPHJDSUHSXFH
Key words: penis; children; foreskin; congenital abnormalities; surgery
Int Braz J Urol. 2008; 34: 313-8
INTRODUCTION &RQJHQLWDOPHJDSUHSXFHLVDPDOIRUPDWLRQ FRQVLVWLQJRIDJUHDWUHGXQGDQF\RIWKHLQQHUSUHSXWLDO VNLQRYHUDQRUPDOSHQLOHVKDIWDQGJODQV7KHSUHSXFH LVQRWUHWUDFWDEOHDQGDEDOORRQLQJRIWKHIRUHVNLQLV SURGXFHGGXULQJWKHPLFWXULWLRQ,WZDV¿UVWGHVFULEHG E\2¶%ULHQHWDOLQDQGVLQFHWKHQRWKHU DXWKRUVKDYHVKRZQWKDWDOWKRXJKDUDUHFRQGLWLRQ LWLVRIWHQFRQIXVHGZLWKEXULHGWUDSSHGFRQFHDOHG ZHEEHGRUPLFURSHQLV 7KHH[XEHUDQWLQQHUSUHSXFHFORVHGE\WKH SUHSXWLDOULQJFUHDWHVDUHVHUYRLUZLWKDODUJHGLPHQ -VLRQOHDGLQJWRWKHDQDWRPLFDODVSHFWRISHQRVFURWDO WUDQVSRVLWLRQ)LJXUHDQG&RPSUHVVLRQRIWKH SHQLOHVKDIWUHVXOWVLQXULQHVSLOODJH)LJXUH7KH GLDJQRVLVLVPDGHWKHUHIRUHHVVHQWLDOO\E\SK\VLFDO H[DPLQDWLRQZKLFKGRHVQRWUHTXLUHIXQFWLRQDOH[ -SORUDWLRQ 7KHREMHFWLYHRIWKLVUHSRUWZDVWRSUHVHQW
D QHZ DOWHUQDWLYH VXUJLFDO WHFKQLTXH WKDW WDNHV LQ account the penoscrotal transposition aspect of the PDOIRUPDWLRQZKLFKSHUPLWVDVDWLVIDFWRU\FRVPHWLF appearance.
MATERIALS AND METHODS
Congenital Megaprepuce: Surgical Correction
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Figure 1 – The arrow shows an aspect of penoscrotal transposi-tion in a patient with megaprepuce.
Figure 2 – Typical penoscrotal ballooning of the congenital megaprepuce.
Figure 3 – 7KH DUURZ VKRZV WKH XULQDU\ MHW ÀRZ ZKHQ WKH foreskin is squeezed.
RESULTS
$OOSDWLHQWVSUHVHQWHGZLWKWKHGLDJQRVLVRI EXULHGSHQLVDQGRXWRIKDYHKDGUHSHDWHGXULQDU\ tract infections. After the surgical treatment all pa-WLHQWVKDYHQRUPDOYRLGLQJSDWWHUQDQGWKHFRVPHWLF DVSHFWZDVFRQVLGHUHGDGHTXDWHWR\HDUVDIWHU VXUJHU\)LJXUHDQG
COMMENTS
&RQJHQLWDOPHJDSUHSXFHZDV¿UVWGHVFULEHG E\2¶%ULHQHWDO,WLVFDXVHGE\DUHGXQGDQWLQQHU SUHSXFHRYHUDSUHSXWLDOULQJZKLFKLVQRWUHWUDFWDEOH OHDGLQJWRDEDOORRQLQJRIWKHIRUHVNLQ&KURQLFDOO\ LW FUHDWHV D UHVHUYRLU ZKLFK UHQGHUV WKH H[WHUQDO genitalia an aspect of a penoscrotal transposition.
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Figure 5 – Traction in the ventral preputial ring changing the broken incision into a strait line.
Figure 4 – A) Correction o penoscrotal transposition. B) Sche-matic drawing. Arrows show the lateral incisions.
A
Congenital Megaprepuce: Surgical Correction
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Figure 6 – A) Cutting the inner prepuce. B) Schematic draw-ing.
Figure 7 – Stitches incorporate the foreskin to the penile shaft.
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A
CONFLICT OF INTEREST
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REFERENCES
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Figure 8 – A) and B) Postoperative surgical aspect.
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Congenital Megaprepuce: Surgical Correction
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Accepted after revision: December 11, 2007
Correspondence address:
