Megameatus intact prepuce, a rare variant of hypospadias: report of two cases and literature review

Megameatus intact prepuce is an unusual variety of the distal hypospadias, characterized by a widely splayed (fishmouth) coronal or subcoronal meatus, a deep glanular groove with normal prepuce, and no chordee. Physically, the glans penis has disunion with an abnormally large meatus associated with a deep glans cleft. Because the foreskin is intact, the condition is frequently overlooked; as a result, the patient seeks medical attention later, when the purpose is to address other urogenital issues. Cosmetic remodeling should be performed to avoid affecting a child’s psychological state. We present 2 cases of the mentioned condition (circumcised and uncircumcised) with blunderbuss external urethral meatuses, admitted to our pediatric surgery department. Both patients underwent tubularized incised plate urethroplasty along with spongioplasty and a vascularized dartos flap over the urethroplasty for fistula prevention. The cosmetic and functional results were satisfactory.