megalourethra is a rare congenital mesenchymal anomaly of the male anterior urethra characterized by a nonobstructive dilatation of the penile urethra .
nesbitt in 1955 defined it as  a congenital dilatation of penile urethra without distal obstruction  .
dorairajan classified congenital megalourethra into two types based on findings of urethrography . the more common scaphoid type with a deficiency of the corpus spongiosum is seen as bulging of ventral urethra .
the fusifrom type with deficiency of both corpus spongiosum and cavernosum is seen as circumferential expansion of urethra .
a 6-month - old male child presented with dribbling of urine with a noticeable swelling of undersurface of penis which increased during the act of micturition . on examination a scaphoid
swelling of size 4  3 cm was seen on the ventral aspect of shaft of penis which ballooned out during micturition .
ultrasound of abdomen and pelvis showed normal kidneys and bladder with no post void residue .
retrograde urethrogram showed scaphoid dilatation of ventral aspect of distal and mid penile urethra confirming the diagnosis of congenital megalourethra [ figure 1b ] .
cystourethroscopy showed wide saccular dilatation of penile urethra about 1 cm from external urethral meatus .
retrograde urethrogram showing ventral saccular dilatation of urethra a reduction urethroplasty was done through circumcoronal penile incision .
after degloving the penis scaphoid dilatation of ventral aspect of penile urethra was noted [ figure 2 ] .
the dilated urethra was incised in ventral midline and the redundant urethra with deficient corpus spongiosum was excised and the urethra was reconstructed over 6 fr infant feeding tube using 5 - 0 pds suture .
postoperative recovery was uneventful . on removal of the catheter after 2 weeks child voided normally without any penile swelling .
regular follow - up at 1 year showed no recurrence of penile swelling with normal voiding pattern and sonologically normal bladder and upper tracts .
the most commonly held theories propose a defect in the migration , differentiation , or development of the mesenchymal tissues of the phallus .
another assumption is that delayed or deficient canalization of the glandular urethra may be associated with maldevelopment of the corpus spongiosum and corpora cavernosae . due to the poor development of erectile tissue which normally provides support
two types of megalourethra are described depending upon the extent of associated embryonic maldevelopment of erectile tissue .
jones et al . , in a review identified associated anomalies in 66 of 78 reported cases of megalourethra . in this review ,
associated congenital anomalies are seen in 80% of scaphoid type and 100% of fusiform type .
the commonly described genitourinary anomalies include renal dysplasia - hypoplasia , hydronephrosis , hydroureter , vesicoureteric reflux , prune - belly syndrome , urethral duplication , megacystis , hypospadias , posterior urethral valves , and undescended testes .
other system anomalies including vater ( vertebral , anal atresia , trachea - esophageal fistula , and renal anomalies ) and vacteryl ( vertebral , anal atresia , cardiac , trachea - esophageal fistula , renal , and limb deformities ) are described . in view of associated anomalies , the workup of megalourethra should include renal function tests and imaging of upper and lower urinary tracts
urethral anomalies mimicking megalourethra like urethral atresia , a web , duplication , and a diverticulum are considered in the differential diagnosis .
prenatally diagnosed megalourethra has to be thoroughly evaluated for associated congenital anomalies and followed up serially by ultrasound for amniotic fluid index , urinary bladder volume , and upper tract dilatation .
termination of pregnancy may be advised in cases with other severe congenital anomalies and renal impairment . in some milder forms of megalourethra spontaneous resolution has been observed in fetuses at 19 - 34 weeks gestation .
the treatment of megalourethra may be one stage or two stage urethroplasty depending on the age of presentation and general condition of the patient . for scaphoid type , nesbitt described a longitudinal reduction urethroplasty .
heaton and colleagues described a technique of urethral plication for some cases of scaphoid megalourethra .
the management of fusiform type is complicated ranging from sex reassignment to major phallic reconstruction .
long - term follow - up is required in these patients to see for the erectile function and fertility potential .
management has to be individualized depending on type and the presence of associated congenital anomalies . in isolated scaphoid type of megalourethra reduction
 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 . 