Meatal stenosis: Difference between revisions

Line 1:

'''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 ==

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 124:

* Balanitis xerotica obliterans

** Balanitis xerotica obliterans (BXO), which is an unusual condition that causes a whitish discoloration and dry appearance of the glans, can also cause meatal stenosis.

** A 10-year retrospective series at [http://www.childrenshospital.org/ Boston Children's Hospital] included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the urethra. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.<ref>{{REFjournal

** A 10-year retrospective series at [http://www.childrenshospital.org/ Boston Children's Hospital] included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the [[urethra]]. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.<ref>{{REFjournal

|last=Gargollo

|init=PC

@@ Line 1: / Line 1: @@
-'''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 ==
@@ 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 124: / Line 124: @@
 * Balanitis xerotica obliterans
 ** Balanitis xerotica obliterans (BXO), which is an unusual condition that causes a whitish discoloration and dry appearance of the glans, can also cause meatal stenosis.
-** A 10-year retrospective series at [http://www.childrenshospital.org/ Boston Children's Hospital] included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the urethra. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.<ref>{{REFjournal
+** A 10-year retrospective series at [http://www.childrenshospital.org/ Boston Children's Hospital] included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the [[urethra]]. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.<ref>{{REFjournal
   |last=Gargollo
   |init=PC