Ballooning of the Prepuce in Phimosis vs. Megalopenis in Urethral Diverticulum
Left picture: A severe phimosis is present here; it is a sequel of a balanoposthitis with scarring and stricture. Therefore, the contrast medium or the urine accumulates between glans and foreskin, distending the end of the penis like a balloon. For permanent cure a total circumcision is necessary. With a clinical examination it would have been possible to diagnose the severe phimosis without a VCUG, on condition that this clinical presentation would have been known, and a precise observation of the micturation would have been performed. Right picture: The club-like distension of this megalopenis does not extend entirely to the tip of the penis: the foreskin is not involved. The figure at the bottom with a lateral view serves as additional demonstration. The cause is a sac-like and large urethral diverticulum which fills during each micturation, at the same time hindering a regular micturation through the anterior urethra.
Left picture: 6-month-old boy with a disorder of bladder voiding, such as episodes of dribbling urine. A regular micturation has never been observed. Following retrograde filling of the bladder with a fine catheter (VCUG) a slightly dilated urethra is apparent, and the contrast medium accumulates distally from and around the glans of the penis in an elongated and balloon-like structure. Right picture: Newborn with an obstruction of the micturation which occurs only drop by drop. The penis is dilated club-like in the distal part.