title: Megameatus intact prepuce hypospadias variant: application of tubularized incised plate urethroplasty.
abstract: OBJECTIVE
  The characteristics of the megameatus intact prepuce (MIP) hypospadias variant present a unique challenge to surgeons. Dissatisfaction with the results of conventional repair methods led to the emergence of several alternative surgical approaches, including the glanular approximation (GAP) and pyramid procedures. The application of tubularized, incised plate (TIP) urethroplasty has not been documented in this setting.
  
  
  METHODS
  Twenty-four patients (mean age 18.5 months, range 6 to 60) presented with MIP. They had all been circumcised. The meatus was glanular in 6, coronal in 15, and distal shaft in 3 patients. Glanular MIP was repaired by meatal advancement and glanuloplasty (n = 2) or the GAP technique (n = 4). Coronal MIP was repaired by the GAP (n = 7) or TIP urethroplasty (n = 8), and distal shaft MIP was repaired by TIP urethroplasty (n = 3). Stents or catheters were used only with TIP urethroplasty. The mean follow-up period was 40 months (range 8 to 80).
  
  
  RESULTS
  Satisfactory cosmetic and functional results were achieved in 20 patients (83%). The other 4 patients included 1 patient who underwent GAP and meatoplasty and 3 of the 11 patients who underwent TIP urethroplasty, of whom 2 underwent meatoplasty and 1 simple local repair of a urethrocutaneous fistula without the need for urethral reconstruction.
  
  
  CONCLUSIONS
  The success rates for all selected techniques were satisfactory. TIP urethroplasty can be successfully used in the more severe, proximal forms of MIP.
authors.affiliation: Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. yuvalbary@hotmail.com
authors.forename: Yuval
authors.initials: Y
authors.lastname: Bar-Yosef
authors.forename: Joseph
authors.initials: J
authors.lastname: Binyamini
authors.forename: Michael
authors.initials: M
authors.lastname: Mullerad
authors.forename: Haim
authors.initials: H
authors.lastname: Matzkin
authors.forename: Jacob
authors.initials: J
authors.lastname: Ben-Chaim
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D007223:Infant; D008297:Male; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods