title: Simplified surgical approach to congenital megaprepuce: fixing, unfurling and tailoring revisited.
abstract: OBJECTIVE
  Megaprepuce is a congenital penile malformation that includes phimosis and severe ballooning of the internal prepuce. We combined the main technical details of 2 previously reported surgical techniques to simplify the surgical approach. We report the key points of this revisited surgical correction for megaprepuce and the long-term results.
  
  
  METHODS
  Penile reconstruction was performed between March 2004 and March 2009 in 26 children 2 to 19 months old (median age 6) with congenital megaprepuce. Surgical repair consisted of limited preputial resection of the phimotic ring, wide dissection of the outer prepuce to the base of the penis, fixation of the proximal outer prepuce to Buck's fascia to create a new penoscrotal junction, and unfurling and wide tailoring of the inner prepuce in the ventral midline to resurface the whole elongated penile shaft. A bladder catheter was left in place for 5 or 6 days. Only patients with at least 6 months of followup were included in analysis.
  
  
  RESULTS
  All patients underwent surgery on an outpatient basis. Operative time was between 50 and 85 minutes. Median followup was 17.6 months (range 6 to 59). Two patients had slight dehiscence of the ventral suture, which healed spontaneously without a scar. In 1 patient transient urethral meatal stenosis developed. The final cosmesis result was adequate in all patients.
  
  
  CONCLUSIONS
  It is possible to correct megaprepuce and achieve an adequate genital aspect with a simple approach of resurfacing the penis with the unfurled, tailored inner prepuce.
authors.affiliation: Section on Pediatric Urology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. eduardo.ruiz@hospitalitaliano.org.ar
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ruiz
authors.forename: Roberto
authors.initials: R
authors.lastname: Vagni
authors.forename: Claudio
authors.initials: C
authors.lastname: Apostolo
authors.forename: Juan
authors.initials: J
authors.lastname: Moldes
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodríguez
authors.forename: María
authors.initials: M
authors.lastname: Ormaechea
authors.forename: Carlos
authors.initials: C
authors.lastname: Giuseppucci
authors.forename: Francisco
authors.initials: F
authors.lastname: de Badiola
authors.forename: Juan
authors.initials: J
authors.lastname: Bortagaray
authors.forename: Carlos
authors.initials: C
authors.lastname: Perea
mesh_terms: D052816:Foreskin / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D013521:Urologic Surgical Procedures, Male / Q000379:methods