Meatal stenosis: Difference between revisions

'''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.

}}</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.

After [[circumcision]] and the loss of the protective [[foreskin]], 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>{{REFjournal

Meatal stenosis affects 9%-10% of males who are circumcised.

Morbidity is limited to the clinical symptoms and complications of surgical repair, including bleeding, infection, and recurrence.

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

=== Sex ===

Children who are not toilet-trained are more prone to develop meatal stenosis after circumcision because of exposure of the meatus to [[urine]] in diapers. Most children who are toilet-trained can verbalize their difficulties during micturition to their caregivers.

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

  |accessdate=2022-01-25

}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.

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.

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

* 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.

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