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{{Construction Site}}'''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.
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== Background ==
|issue=5
|pages=526-528
|url=https://www.sciencedirect.com/science/article/abs/pii/S1477513110004341
|quote=
|pubmedID=20851685
|pubmedCID=
|DOI=10.1016/j.jpurol.2010.08.005
|date=2011-10
|accessdate=2020-02-01}}</ref> Meatal stenosis is a relatively common acquired condition occurring in 910%-1020% 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 ==
After circumcision, 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 uncircumcised 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, 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
|last=Van Howe
|first=R.S.
|author-link=Robert S. Van Howe
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
|journal=Clin Pediatr (Phila)
|issue=1
|pages=49-54
|url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting
|quote=
|pubmedID=16429216
Observation of the child while voiding helps immensely in confirming the diagnosis of the disorder.
If the physician desires to calibrate the meatus, Litvak ''et al ''. report that the meatus in children younger than 1 year will accept a lubricated 5F feeding tube. They also report that, in children aged 1-6 years, an 8F feeding tube should pass without difficulty.<ref>{{REFjournal
|last=Litvak
|first=A.S.
|url=
|quote=
|pubmedID=940216
|pubmedCID=
|DOI=10.1016/s0022-5347(17)59355-6
|date=1976-06
|accessdate=2020-02-01
}}</ref>
* 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
|last=Gargollo
|first=P.C.
|url=
|quote=
|pubmedID=16145451
|pubmedCID=
|DOI=10.1097/01.ju.0000173126.63094.b3
|date=2005-10
|accessdate=2020-01-01
}}</ref>
** In children with BXO, meatal stenosis seems to be quite common.
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
|last=Brown
|first=M.R.
|url=
|quote=
|pubmedID=9326954
|pubmedCID=
|DOI=10.1016/s0031-3955(05)70549-6
|date=1997-10
|accessdate=2020-02-01
}}</ref>
* Divide the crushed area with a straight fine-tipped scissor and apply an antibiotic ointment.
* After the operation, it is critical that the caregivers separate the edges of the meatus and apply antibiotic ointment or petroleum jelly twice a day for 2 weeks and then once a day for another 2 weeks to prevent one side of the meatotomy from adhering to the other side. Some medical professionals recommend dilation with a lubricated feeding tube or the tip of an ophthalmic ointment tube for a period of 4-8 weeks.
* In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and & Smith (2000) found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only 1 patient had recurrent meatal stenosis).<ref>{{REFjournal
|last=Smith
|frist=C.
|url=
|quote=
|pubmedID=10688093
|pubmedCID=
|DOI=10.1016/s0090-4295(99)00571-3
|date=2000-02
|accessdate=2020-02-01
}}</ref>
* Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child in a tub of warm water may stimulate micturition.
[[Category:Penile illness]]
[[Category:Medicine]]
[[Category:Medical conditions]]
[[de:Meatusstenose]]