Congenital megalourethra complicated by circumcision

ABSTRACT

Congenital megalourethra [CMU] is a rare anomaly of the male urethra in which there is a non-obstructive dilatation of the penile urethra. Children usually present with an abnormal appearance of penis and ballooning of the penis during voiding. Diagnosis is easy by typical external appearance of the floppy penis. We report a case of CMU with an abnormal looking penile urethra resulted due to circumcision, carried out by the inexperienced traditional circumcision practitioner, [Nai]. A six years old child was referred with an abnormal appearance of the penis. At the age of two months, a traditional circumcision practitioner [Nai] carried out his circumcision, which led to an abnormal looking penile urethra. During this period, the child had two episodes of urinary tract infection. His urinary stream was good and he had no other urinary symptoms. Examination revealed a good sized penis with floppy large opening of the distal penile urethra. There was a wide urethral plate on the ventral surface of glans penis and the most distal part of corpora cavernosa were not palpable. Child, however, had normal erection. Diagnosis of congenital megalourethra complicated by circumcision was made because of the typical external appearance. Ultrasonography revealed bilateral hydroureter with hydronephrosis. Micturating cystourethrogram showed grade 4 vesicoureteric reflux on right side and grade 3 on left side. Isotope renal scans showed bilateral renal scarring, good renal function on both sides and differential functions of 35% and 65% on right and left side respectively. The child was operated and bilateral ureteric reimplantation performed. Six months follow-up visits showed stable renal functions, no evidence of vesicoureteric reflux. He is awaiting for repair of megalourethra, which shall be performed by Nesbit technique.2