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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.
== Background ==
|date=2011-10
|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.
== 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.
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
==== International ====
Meatal stenosis affects 10%-20% of males who are [[circumcised ]] in infancy.
=== Mortality/Morbidity ===
=== Race ===
Meatal stenosis has no racial predilection. The condition can occur in [[circumcised ]] males independent of ethnicity.
=== Gender ===
=== 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
|last=Brennemann
|init=J
|issue=
|pages=38-47
|accessdate=20222024-0102-2504}}</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:
=== 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.
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.
[[File:Kid_Friendly_Approach_to_Meatal_Stenosis.pdf]]
{{SEEALSO}}* [[Meatus]]
{{REF}}