Meatal stenosis - Revision history

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	=== Causes ===		=== Causes ===

	In a child who is circumcised, persistent exposure of the meatus to [[urine]] and mechanical trauma from rubbing against a wet diaper results in ammoniacal dermatitis,<ref name="brenneman1921">{{REFjournal		In a child who is [[circumcised]], persistent exposure of the [[meatus]] to [[urine]] and mechanical trauma from rubbing against a wet diaper results in ammoniacal dermatitis,<ref name="brenneman1921">{{REFjournal
	\|last=Brennemann		\|last=Brennemann
	\|init=J		\|init=J
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	\|pages=38-47		\|pages=38-47
	\|accessdate=2024-02-04		\|accessdate=2024-02-04
	}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.		}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the [[glans]].

	Other causes of meatal stenosis include the following:		Other causes of meatal stenosis include the following:
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	=== Surgical care ===		=== Surgical care ===

	Serial dilatation results in small tears of the meatus, which are followed by secondary healing. In the long term, this creates a tighter stricture at the tip of the penis; therefore, this procedure is discouraged.		Serial dilatation results in small tears of the meatus, which are followed by secondary healing. In the long term, this creates a tighter stricture at the tip of the [[penis]]; therefore, this procedure is discouraged.

	Meatotomy is the definitive treatment for meatal stenosis. Meatotomy is a simple procedure in which the ventrum of the meatus is crushed (for hemostasis) for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors.		Meatotomy is the definitive treatment for meatal stenosis. Meatotomy is a simple procedure in which the ventrum of the meatus is crushed (for hemostasis) for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors.

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	\|date=2011-10		\|date=2011-10
	\|accessdate=2020-02-01		\|accessdate=2020-02-01
	}}</ref> Meatal stenosis is a relatively common acquired condition occurring in 10%-20% of males who are [[Circumcision\| circumcised]]. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.		}}</ref> Meatal stenosis is a relatively common acquired condition occurring in 10%-20% of males who are [[Circumcision\| circumcised]]. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged [[urination]]. Surgical meatotomy is curative.

	== Pathophysiology ==		== Pathophysiology ==

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	[[File:Kid_Friendly_Approach_to_Meatal_Stenosis.pdf]]		[[File:Kid_Friendly_Approach_to_Meatal_Stenosis.pdf]]
			{{SEEALSO}}
			* [[Meatus]]
	{{REF}}		{{REF}}

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	\|issue=		\|issue=
	\|pages=38-47		\|pages=38-47
	\|accessdate=~~2022~~-01-25		\|accessdate=2024-02-04
	}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.		}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.

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	=== Race ===		=== Race ===

	Meatal stenosis has no racial predilection. The condition can occur in circumcised males independent of ethnicity.		Meatal stenosis has no racial predilection. The condition can occur in [[circumcised]] males independent of ethnicity.

	=== Gender ===		=== Gender ===

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	==== International ====		==== International ====

	Meatal stenosis affects 10%-20% of males who are circumcised in infancy.		Meatal stenosis affects 10%-20% of males who are [[circumcised]] in infancy.

	=== Mortality/Morbidity ===		=== Mortality/Morbidity ===

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	== Pathophysiology ==		== Pathophysiology ==

	After [[circumcision]] and the loss of [[Foreskin#Protective_functions\| foreskin protection]], a child who is not toilet-trained persistently exposes the [[meatus]] to [[urine]], resulting in inflammation (ammoniacal dermatitis) and mechanical trauma as the meatus rubs against a wet diaper (nappie). This causes the loss of the delicate epithelial lining of the distal [[urethra]]. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in [[intact]] children, [[circumcision]] is believed to be the most important causative factor of meatal stenosis.		After [[circumcision]] and the loss of [[Foreskin#Protective_functions\| foreskin protection]], a child who is not toilet-trained persistently exposes the [[meatus]] to [[urine]], resulting in inflammation (ammoniacal dermatitis) and mechanical [[trauma]] as the meatus rubs against a wet diaper (nappie). This causes the loss of the delicate epithelial lining of the distal [[urethra]]. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in [[intact]] children, [[circumcision]] is believed to be the most important causative factor of meatal stenosis.

	Another hypothetical cause of this condition is ischemia due to damage to the frenular artery during [[circumcision]], resulting in poor blood supply to the meatus and subsequent stenosis. In a prospective study of circumcised boys, [[Robert S. Van Howe\|Van Howe]] (2006) found meatal stenosis in 24 of 239 (7.29%) children older than 3 years, making meatal stenosis the most common complication of circumcision.<ref name="vanhowe2006">{{REFjournal		Another hypothetical cause of this condition is ischemia due to damage to the frenular artery during [[circumcision]], resulting in poor blood supply to the meatus and subsequent stenosis. In a prospective study of circumcised boys, [[Robert S. Van Howe\|Van Howe]] (2006) found meatal stenosis in 24 of 239 (7.29%) children older than 3 years, making meatal stenosis the most common complication of circumcision.<ref name="vanhowe2006">{{REFjournal

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	'''Meatal stenosis''' is a narrowing of the ''meatus'' (the opening of the [[urethra]]). Meatal stenosis is extremely rare in [[intact]] boys with a protective [[foreskin]]. About twenty percent of circumcised boys develop meatal stenosis. Meatal stenosis may be prevented by avoiding child [[circumcision]], which is a medically-unnecessary, non-therapeutic surgical [[amputation]] procedure.		'''Meatal stenosis''' is a narrowing of the ''meatus'' (the opening of the [[urethra]]). Meatal stenosis is extremely rare in [[intact]] boys with a protective [[foreskin]]. About twenty percent of [[circumcised]] boys develop meatal stenosis. Meatal stenosis may be prevented by avoiding child [[circumcision]], which is a medically-unnecessary, non-therapeutic surgical [[amputation]] procedure.

	== Background ==		== Background ==

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	}}</ref>		}}</ref>

	* If the caregivers and the patient are cooperative, this procedure can be performed in the office of the physician using a topical eutectic mixture of local anesthetics (EMLA cream) applied liberally over the entire glans and secured in place for at least one hour with an occlusive dressing.		* If the caregivers and the patient are cooperative, this procedure can be performed in the office of the physician using a topical eutectic mixture of local anesthetics ([[EMLA]] cream) applied liberally over the entire glans and secured in place for at least one hour with an occlusive dressing.
	* After being in place for one hour, the dressing is removed and the penis is prepared and draped into a sterile field.		* After being in place for one hour, the dressing is removed and the penis is prepared and draped into a sterile field.
	* Throughout this procedure, reassure the child and tell him what is being done.		* Throughout this procedure, reassure the child and tell him what is being done.

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	Meatotomy is the definitive treatment for meatal stenosis. Meatotomy is a simple procedure in which the ventrum of the meatus is crushed (for hemostasis) for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors.		Meatotomy is the definitive treatment for meatal stenosis. Meatotomy is a simple procedure in which the ventrum of the meatus is crushed (for hemostasis) for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors.

	Brown et al. (1997) reported excellent results following 130 office meatotomies with only 2 recurrences of meatal stenosis and 1 patient with bleeding requiring stitches. They also cited the cost-effectiveness of this treatment and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation, as their presence seemed to have a calming effect.<ref>{{REFjournal		Brown et al. (1997) reported excellent results following 130 office meatotomies with only 2 recurrences of meatal stenosis and 1 patient with [[bleeding]] requiring stitches. They also cited the cost-effectiveness of this treatment and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation, as their presence seemed to have a calming effect.<ref>{{REFjournal
	\|last=Brown		\|last=Brown
	\|init=MR		\|init=MR
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	=== Complications ===		=== Complications ===

	Complications include bleeding during or after meatotomy, infection, and recurrence. All of these complications are quite rare and respond readily to appropriate management.		Complications include [[bleeding]] during or after meatotomy, infection, and recurrence. All of these complications are quite rare and respond readily to appropriate management.

	Mild dysuria may persist for 1-2 days. Placing the child in a tub of warm water may provide relief.		Mild dysuria may persist for 1-2 days. Placing the child in a tub of warm water may provide relief.