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Hypospadias Surgery • Basics

Megameatus Intact Prepuce (MIP): Hypospadias With a Normal-Looking Foreskin

The hooded-foreskin appearance that is the classic sign of hypospadias is absent in this subtype; the foreskin is normal all the way around. The opening, however, is wide and sits further back than it should. Because of this, the condition is usually only noticed at the time of circumcision.

Who this is forCases noticed at the time of circumcision
Reading≈2 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of hypospadias surgery.Read the full treatment overview on the hub page
where it should beCoronal
underside view
01 · Why is it missed?02 · Findings03 · Treatment
In brief3 madde
  • Why is it missed?: The first sign families and doctors look for with hypospadias is the foreskin gathering on top and being incomplete underneath.
  • Findings: The foreskin is complete and looks normal.
  • Treatment: Results in this group are quite good.
01

Why is it missed?

The first sign families and doctors look for with hypospadias is the foreskin gathering on top and being incomplete underneath. In MIP, this sign is absent; from the outside, the penis looks completely normal.

  • For this reason, in every baby scheduled for circumcision, the foreskin should be pulled back and the position of the opening checked directly. Otherwise, the condition only comes to light after the foreskin has been removed.
02

Findings

  • The foreskin is complete and looks normal.
  • The urinary opening is wider than normal (megameatus).
  • The opening is within the glans, further back than it should be.
  • Curvature usually does not accompany it.
03

Treatment

Results in this group are quite good. If the stream is straight and the opening is far enough forward, monitoring is also a valid option; the decision is made together with the family.

  • When repair is preferred, the TIP (Snodgrass) technique is usually used to narrow the wide opening and move it to the tip. If the groove is very good, a more limited correction such as GAP may be enough.
Related videos
Full guide (19) →
Frequently asked questions
The condition was noticed once circumcision had already started — what should be done?
The procedure should be stopped at that point and the skin preserved. The foreskin is tissue that can be used in the repair; if it's removed, the options narrow.
What determines whether we choose monitoring?
Monitoring is reasonable if the stream is straight and single-directional, the opening is far enough forward, and the family isn't bothered by the appearance. This assessment is made at the examination.
←Previous • BasicsHypospadias and Penile Curvature (Chordee)Next • Basics"Born Circumcised" Appearance→
Related pagesFull index →
BasicsHypospadias and CircumcisionThis page has one message, and it is the most important one: circumcision should not be performed while hypospadias is suspected. The foreskin is the single most valuable spare tissue for the repair, and once removed it cannot be brought back.Surgical TechniquesTIP (Snodgrass) RepairTIP is the most widely used technique for hypospadias repair worldwide. Its logic is simple: the existing groove is deepened along the midline, widened, and turned into a tube — so the new channel is built entirely from the patient's own tissue.Surgery in ChildrenDistal Hypospadias SurgeryThe opening is at or just below the head of the penis, and there is no significant curvature. This is the most common and best-outcome form of hypospadias; repair is completed in a single operation, and the child usually goes home the same day or the next.BasicsTypes of HypospadiasIn hypospadias, the whole plan starts with a single piece of information: where is the urinary opening? How far back it sits from the tip directly determines which technique is used and how many stages the repair needs.
Hypospadias Surgery topic clustersMain treatment page →
Basics 8Surgery in Children 8Surgical Techniques 5After Surgery 9Recurrent Cases 4Hypospadias in Adults 8Follow-up and Assessment 5
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