Congenital megaprepuce: description of a simple, reproducible novel surgical technique

Abstract

Background and objectives: A buried penis, secondary to congenital megaprepuce (CMP), is a specific clinical entity plagued by the non-uniform use of terminology and many surgical repair techniques that have brought confusion to this subject. The results of surgery have been mixed and no technique is superior to another. This study aims to provide a brief review of the literature on CMP, describe a  simple, reproducible novel surgical repair technique, and retrospectively review the first series of patients managed by this method.

Method: A total of 16 boys aged between 10 and 43 months were referred with CMP and operated on by the same surgeon (JH) from 1 February 2017 to 31 July 2022, using the same method, termed an “inverted circumcision”.

Operative approach: See Appendix A: Video of inverted circumcision procedure. A ventral longitudinal incision crossing the penoscrotal junction was made on all patients. Dissection was done between the dartos fascia and Buck’s fascia. The penis was delivered through the incision for the inverted circumcision. Anchoring sutures were placed between the dermis and Buck’s fascia to recreate the penoscrotal and penopubic junctions. The phallus was replaced into the shaft skin and the excess inner prepuce was trimmed accordingly. Circumferential suturing was done and all patients had the appearance of a circumcised penis. The minimum follow-up was six weeks.

Results: Good to excellent anatomical outcome was subjectively recorded according to assessment by the reviewing surgeon. None of the patients needed reoperation to improve the outcome.

Conclusion: The inverted circumcision technique is a simple, reproducible technique and should be added to the surgical options of correcting a buried penis secondary to CMP.