Megameatus Intact Prepucia (MIP): Hypospadias Variant
Megameatus intact prepuce (MIP) is a variant of Hypospadias which is not commonly seen. Among all hypospadias patients, it may be present in 1–3% of patients. It is a unique variety and relatively rare as compared to other varieties.
Its name is also unique and shows all the diagnosis in itself. “Megameatus” means a large urine opening, and “Intact Prepuce” means that penile skin is normally looking.
Presentation:
Usually, these patients are not diagnosed at birth. These children have normal penile skin, like normal children. However, some children may have short skin on the downside (as seen in Hypospadias children).
The urine hole in these children is large as compared to normal children. It is covered with normal penile skin, so they are not identified at birth. When these children present for circumcision, then the surgeon identifies this variety.
Any experienced pediatric surgeon can easily identify this variety. During circumcision, when the surgeon removes the penile skin, he observes the large urine hole.
Usually, no further blood tests are required for it.
Treatment:
The treatment for this variety is surgery. The reason for the surgery of these patients include:
• As these children have a large urine opening, so they can’t aim their urine stream. Their urine sprays everywhere and is not targeted.
• There is a possibility that their penis may be bent as well. Due to this bending, they may have a urination problem and some pain during intercourse in adult life.
• This is a deformity that involves a sensitive organ. The corrective surgery of this organ is as important as the surgery for lip or face deformities.
The surgery for this variety is relatively simple. Although very sensitive, there are fewer chances of complication. The success rate of surgery is high as compared to other varieties of Hypospadias.
After the surgery, the urinary catheter is usually left there for 2–3 days. After this period, the catheter is removed. Usually, these children heal without any further complications.
Although it is a relatively simple variety, still there are lot many variants of MIP. Due to this reason, no single procedure may be labeled as the gold standard for MIP.
Many factors may determine the type of surgical procedure like:
• Size of urine hole
• Depth of urine hole
• Amount of skin present around the penis
• Bending of the penis (Chordee)
• Size of the head of the penis (Glans)
There is a small group of people who don’t advise and recommend surgery for this variety. Decision is upto parents after going through all pros and cons.