title: Repair of megameatus: a modified approach.
abstract: OBJECTIVE
  To demonstrate surgical reconstruction of a megameatus variant of hypospadias by using a modified, patient-specific approach.
  
  
  METHODS
  An 8-month-old male had a megameatus, which was discovered after newborn circumcision. In repair of megameatus, it is important to recognize the full extent to which the distal urethra is widened, in order to avoid inadvertent urethrotomy during mobilization of the glans wings and skin immediately proximal to the glans. In this case, a small wedge of tissue was excised from the ventral aspect of the urethra, and a midline relaxing incision of the urethral plate was made. Standard principles of hypospadias repair should be followed, with tension-free urethral tubularization, coverage of the neourethra with well-vascularized tissue, and adequate mobilization of the glans wings to allow midline reconstruction without compression of the underlying neourethra.
  
  
  RESULTS
  There were no perioperative or postoperative complications in this case. The urethral meatus was positioned near the tip of the glans penis, and there was no evidence of meatal stenosis or urethrocutaneous fistula at 5-months follow-up.
  
  
  CONCLUSIONS
  Each case of megameatus is unique, and a variety of surgical techniques can be used in formulating an approach that achieves optimal cosmetic and functional outcomes.
authors: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 24, Chicago, IL 60611, USA. Electronic address: mfaasse@sbcglobal.net.
authors: M A
authors: MA
authors: Faasse
authors: Department of Urology, Loyola University Stritch School of Medicine, 2160 South 1st Ave., Maywood, IL 60153, USA. Electronic address: elizdray@gmail.com.
authors: E V
authors: EV
authors: Dray
authors: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 24, Chicago, IL 60611, USA. Electronic address: echeng@luriechildrens.org.
authors: E Y
authors: EY
authors: Cheng
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D057285:Precision Medicine / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D013536:Suture Techniques; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Hypospadias; Megameatus with intact prepuce; Pediatric; Pyramid procedure; Surgical technique; Tubularized incised plate