Megalourethra with posterior urethral valves

Congenital megalourethra

Background

Congenital megalourethra is a urogenital anomaly characterized by a cystic dilatation and elongation of the penile urethra resulting from the absence and hypoplasia of the corpus spongiosum and corpus cavernosum, or anterior urethral valve. There are two clinical types: scaphoid and fusiform. Generally, the etiology is unknown, but it is thought to be a defect in mesodermal development. Fewer than 100 cases have been reported in the literature, and the exact incidence is unclear. In most cases, the surgical procedure is challenging and requires extensive reconstructive and/or replacement surgery.

Case presentation

We present a 6-month-old boy suffering from a cystic dilatation of the penile urethra along with urine dribbling during micturition since birth. The patient was diagnosed with the scaphoid type of megalourethra and was operated on using reduction urethroplasty. On the 21st post-operative day, we removed the Foley catheter and followed the patient on two occasions (the 45th post-operative day and the 6th post-operative month) with excellent results.

Conclusion

The anagement of megalourethra depends on the clinical type. Meticulous surgical technique, the use of fine suture materials with careful handling, and fixation of the vascularized flap are the main principles of an acceptable result. Observation of erectile function and fertility require long-term follow-up.

Congenital Scaphoid Megalourethra: A Case Report

A congenital megalourethra is an enlargement of the pendulous urethra without evidence of distal obstruction. A 1-month-old boy presented to us with complaint of weak stream, ballooning of the penis before and during voiding and post voiding dribbling, since birth. Physical examination and cystourethroscope confirmed the diagnosis of congenital scaphoid megalourethra. He underwent reduction urethroplasty. During postoperative follow up, he had normal looking penis with good urinary stream.

Isolated megalourethra: A rare case report and review of literature

Megalourethra is a rare congenital disorder of anterior urethra and erectile tissue of penis. It mainly appears in two types—a milder scaphoid type and severe fusiform type. Fusiform type is commonly associated with congenital anomalies of various systems of the body. Isolated megalourethra without other congenital anomalies is extremely rare. We report one such case which was detected postnatally and successfully treated by reduction urethroplasty.

Posterior urethral valve associated with orthotopic ureterocele

Symptomatic presentation of orthotopic ureterocele in infancy is very rare and its association with posterior urethral valves has not been reported till date. The first such case and a review of the literature on anomalies in association with posterior urethral valves is presented.

Congenital megalourethra: outcome after prenatal diagnosis in a series of 4 cases

OBJECTIVE

The purpose of this series is to describe the prenatal sonographic findings and pregnancy outcome in 4 cases of congenital megalourethra.

METHODS

Three cases of fusiform-type megalourethra and 1 case of scaphoid-type megalourethtra were diagnosed prenatally by sonography between 20 and 24 weeks' gestation. The key findings for diagnosis included sonographic features of lower urinary tract obstruction in association with dilatation and elongation of the penile urethra in all 4 cases. Severe oligohydramnios was detected at the time of diagnosis in only 1 case. Prenatal chromosome analysis was available in 3 cases and revealed a normal 46,XY karyotype. Information on pregnancy outcome was available in all cases.

RESULTS

The parents opted for elective termination of pregnancy in 1 case when decreased amniotic fluid volume and echogenic kidneys were documented at the follow-up scan. Among the 3 ongoing pregnancies, there were 2 premature cesarean deliveries at 28 and 31 weeks and 1 vaginal delivery at term. All neonates had severe lung hypoplasia and died in the early neonatal period.

CONCLUSIONS

Congenital megalourethra is associated with poor perinatal outcome. Because this condition can be diagnosed prenatally in the context of lower urinary tract obstruction, detailed examination of the external genitalia in these cases should be mandatory.

Congenital scaphoid megalourethra: Report of two cases

Congenital megalourethra is a rare congenital malformation of the penile urethra. It is defined as the diffuse dilatation of the anterior urethra due to the absence of development of the erectile tissue of the penis. Since the initial description, nearly 80 cases with megalourethra have been reported in English literature. Congenital megalourethra has been classified into scaphoid and fusiform types and is usually associated with additional urinary tract and other system anomalies, irrespective of its type and severity. We report two rare cases of scaphoid megalourethra without any associated anomaly. A 13-year-old boy and an 8-month-old boy were admitted to the Department of Pediatric Surgery with complaints of penile swelling and dysuria since birth. Physical examination and retrograde cystourethrogram confirmed the diagnosis of congenital scaphoid megalourethra. Both patients underwent a reduction urethroplasty. They did well postoperatively and voided with a normal stream without any abnormality of the penile shaft.