Penile Median Raphe Anomalies as an Indicator of Megameatus Intact Prepuce Anomaly in Children Undergoing Routine Circumcision - Beyond the Abstract

MIP is a challenging not only for management and correction but also for recognition and diagnosis. There are several differences between MIP and typical distal hypospadias. Obviously, MIP by definition is associated with a completely formed prepuce, the meatus is abundantly wide and ventral curvature is much less likely. So, if a morphological appearance of the external genitalia could give the physician a hint about the presence of this rare hidden anomaly, it will be helpful to sort out such cases among babies and children committing for routine non-medical circumcision and to refer them to a specialized center for proper reconstruction.

Examination of the penoscrotal raphe is simple to perform and detection of any anomalies, mainly deviation to one side, hyperpigmentation or prominence are significant indicators for the presence of megameatus intact prepuce. A thorough examination of the penile median raphe and appreciation of any deviation from normal should rouse the suspicion about the presence of a megameatus with an intact prepuce. 

Median raphe anomalies, mainly deviation and hyperpigmented prominent raphe are significant indicators for the presence of a hidden megameatus intact prepuce, also abnormal long prepuce may be seen in such cases, but this is not common.

Written by: M A Baky Fahmy MD, FRCS, Professor of Pediatric Surgery, Editor-in-chief Journal of Pediatric Diseases

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