We read with interest the recent article on ‘Congenital Fluctuant Penile Swelling’ [1]. In this article authors have described a large anterior urethral diverticulum in a 15-month old male child presenting with a ventral penile mass, which was getting more prominent during micturition.Micturating cystourethrogram (MCU) and subsequent surgery proved it to be a large anterior urethral diverticulum.

Radiologically, image (MCU) provided by authors closely resembles that of congenital scaphoid megalourethra.Congenital megalourethra is a known but rare congenital malformation of the penile urethra [2-5]. It is defined as diffuse dilatation of the anterior urethra which may be due to absence of development or deficiency of erectile tissue of penis [3-5]. This particular congenital anomaly is known to affect the anterior part of urethra and usually causes abnormal shape and size of the penile shaft, especially during voiding [3]. Megalourethra, traditionally has been divided into scaphoid and fusiform sub-types. The scaphoid form of megalourethra (more common) is due to poor development of the corpus spongiosum in the anterior urethra whereas the fusiform type is believed to be due to maldevelopment of both corpus spongiosa and corpus cavernosa [3-5].

Megalourethra is known to be associated with other abnormalities of the urinary tract, and these include hydronephrosis, renal dysplasia, vesicoureteric reflux, prune-belly syndrome, urethral duplication, undescended testes and posterior urethral valves [3-5].

Although some authors earlier believed that congenital anterior urethral diverticula and megalourethra are in the same spectrum of a single malformation [3], however, Appel, et al. [6] differ from this and believe that congenital urethral diverticula are different from megalourethra, as it is associated with narrow orifices as well, thereby causing obstruction by luminal compression by filling, whereas megalourethra does not have a true distal anatomic obstruction.

The other possible differential diagnoses of megalourethra to be ruled out include congenital urethral diverticulum, anterior urethral valve, Cowper’s syringocele and congenital urethral stricture. In most of these cases, micturating cystourethrogram (MCU) would clinch the diagnosis.

1. Panda SS, Das RR, Bajpai M. Congenital fluctuant penile swelling. Indian Pediatr. 2013;50;533.

2. Nesbitt TE. Congenital megalourethra. J Urol. 1955;73:839-42.

3. Ozokutan BH, Küçükaydin M, Ceylan H, Gözüküçük A, Karaca F. Congenital scaphoid megalourethra: report of two cases. Int J Urol. 2005;12:419-21.

4 . Jones EA, Freedman AL, Ehrlich RM. Megalourethra and urethral diverticula. Urol Clin North Am. 2002;29:341-8.

5. Khan RA, Wahab S, Ullah E. Clinics in diagnostic imaging (130). Congenital megalourethra. Singapore Med J. 2010; 51:352-5.