Meatal stenosis: Difference between revisions
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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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|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 == | ||
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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==== 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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=== 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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=== 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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|issue= | |issue= | ||
|pages=38-47 | |pages=38-47 | ||
|accessdate= | |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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}}</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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[[File:Kid_Friendly_Approach_to_Meatal_Stenosis.pdf]] | [[File:Kid_Friendly_Approach_to_Meatal_Stenosis.pdf]] | ||
{{SEEALSO}} | |||
* [[Meatus]] | |||
{{REF}} | {{REF}} | ||