Meatal stenosis: Difference between revisions

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== Pathophysiology ==

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.

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

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=== Age ===

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.

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.

== Clinical presentation ==

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Patient history may include the following:

* Difficult-to-aim (upward deflected), high-velocity (long distance) stream of urine

* Difficult-to-aim (upward deflected), high-velocity (long distance) stream of [[urine]]

* Pain upon initiation of micturition

* Need to stand back from toilet or sit during urination

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=== 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, loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.

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, 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:

@@ Line 26: / Line 26: @@
 == Pathophysiology ==
-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.
+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
@@ Line 71: / Line 71: @@
 === Age ===
-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.
+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.
 == Clinical presentation ==
@@ Line 79: / Line 79: @@
 Patient history may include the following:
-* Difficult-to-aim (upward deflected), high-velocity (long distance) stream of urine
+* Difficult-to-aim (upward deflected), high-velocity (long distance) stream of [[urine]]
 * Pain upon initiation of micturition
 * Need to stand back from toilet or sit during urination
@@ Line 115: / Line 115: @@
 === 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, loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.
+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, 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: